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TREATISE 



DISEASES AND HYGIENE 



OF THE ORGANS OF 



THE VOICE 



B Y 

COLOMBAT DE I/ISERE, 

CHEVALIER OF THE ROYAL ORDER OF THE LEGION OF HOXOK> 
DOCTOR OF MEDICINE, FOUNDER OF THE ORTHOPHONIC INSTI- 
TUTE OF PAKIS, FOR THE TREATMENT OF ALL VICES OF 
SPEECH, DISEASES OF THE VOICE, ETC. 



TRANSLATED BY 

J. F. \V. LANE, M. D, 



> r ^ of Con.o--. 

BBCOND ^J&I TION, 3 

■ 

BOSTON: 

REDDING & COMPANY, 8 STATE STREET, 

1 857, 



•Cti 



Entered according to Act of Congress, in the year 1845, by 

Oris, Bro.adf.rs and company, 
in the Clerk's Office of the District Court of Massachusetts. 






DESCRIPTION OF THE FRONTISPIECE. 



In this plate a vertical section is supposed to" have been made in 
the neck, immediately in front of the spinal column, and between 
it and the organs of the voice. The observer looks from behind 
forwards. The five first figures refer to bony portions of the skull. 

1, the occipital process. 

2, 2, portions of the temporal bones. 

3, 3, great wings of the sphenoid bone. . - * 

4, 4, condyles of the lower jaw. 

5, 5, branches of the lower jaw. 

6, 6, 6, 6, divided edges of the pharynx drawn outwards. 

7, 7, the posterior nasal openings, corresponding to the nasal 
fossae, or sinuses. 

8, the separation of the two fossae covered by mucous membrane. 

9, 9, the openings of the Eustachian tube. 

10, the soft palate. 

11, 11, an elevation marking the site of the levator palate muscle. 

12, the uvula. 

13, 13, posterior opening of the fauces, or the isthmus. 

14, 14, the tonsils. 

15, root of the tongue. 

16, epiglottis. 

17, the opening into the larynx. 

18, 18, aryteno-epiglottidean folds of mucous membrane. 

19, convexity of the larynx. 

20, 20, two slight projections corresponding to the ascending horns 
of the thyroid cartilage. 

21, the opening into the oesophagus. 

22, the trachea divided transversely. 

[13] 



TABLE OF CONTENTS. 



Translator's Preface, , . ix 

Description of Frontispiece, xiii 

Description of the Vocal Instrument, 1-11 

Vocal organs, 1 ; larynx, 2 ; vocal cords, 7 ; muscles, 10. 

The Voice and its Formation, 12-26 

Difference of the voice as regards age, sex, etc., 13 ; what an- 
imals are capable of producing a vocal sound, 14; fishes 
and insects have no voice, 14 ; modification of the voice by 
circumstances, 15: the voice weaker after a meal, 15 ; this 
organ cannot be imitated by art, 16 ; the famous statue of 
Memnon, 16; singing is a modification of the voice, 17; 
singing natural to man, 17 ; opinions of Rousseau and Blu- 
menbach, 18 ; case of a deaf mute, 18 ; influence of the pas- 
sions upon the voice, 19 ; the difference of the vocal timbre 
depending upon the moral qualities and inclinations of the 
individual, 19 ; sympathies of the voice, 20 ; inflexions of the 
voice with regard to climate and nation, 21 ; extent and sys- 
tem of the voice in music, 23 ; difference between the artic- 
ulated and modulated voice, 24. 

Mechanism of the Voice, 26-51 

Expiration of the air necessary to the voice, 23 ; different theo- 
ries of the vocal mechanism, 29 ; opinions of Aristotle, Galen, 
Fabricius, Casserius, Dodart, Ferrein, Bichat, Richerand, 

A* 



VI TABLE OF CONTENTS. 

Cuvier, Dutrochet, Magendie, Biot, Savard, Despinay, 29 5 
former opinion of the author, 35 3 criticism upon all ancient 
and modern opinions, 37 ; case of a vocal anomaly in a singer 
of the Italian theatre, 42 3 opinion of the author upon the 
mechanism of the spoken voice, and of singing in the grave 
notes, 46. 

The Pharysgean Voice, or Faucette, «... ^. ....... . .52-90 

The glottis is not the only organ productive of sounds, 52 3 
mechanism of the sounds of the faucette, 53 3 organs which 
participate in it, 54 3 experiment of M. Deleau, 56 ; etymology 
of the word faucette^ 58 3 theory of M. Bennati, 60 ; peculiar 
conformation of the vocal organs in base and soprani singers, 
63 3 particular diseases of each class of singers, 64 3 why 
the exercise of singing is more fatiguing than that of 
speaking, 65 ; physiological disorders resulting from singing, 
663 the most natural object of singing, 683 hygienic ad- 
vantages to be derived from this exercise, 69 3 its effects upon 
the nervous system and nervous diseases, 70 3 its protective 
powers in epidemic diseases, 70 3 singers and musicians are 
less exposed to epidemics, 70 3 honors paid to singing among 
the ancients, particularly the Greeks, 71 3 singing pleasant to 
all men, 71 3 united with music it constitutes the chief orna- 
ment of our large assemblies and our theatres, 71 3 it elevates 
the soul of man to God, 71 3 it inspires great actions and vir- 
tue, 71 3 it excites courage and all the passions, 71 j change 
of the voice at the period of puberty, 72 3 precautions to be 
taken at this period,. 72 3 dangers of continuing the exercise of 
singing when certain conditions are not complied with, 72 ; 
what class of persons ought not to sing, 75 3 vocal illusions,. 
77 3 ventriloquy, 77 3 various opinions about ventriloquy, 78 3 
definition of the cry, 83 3 its mechanism, 85 3 its variations in 
every pain, 86 3 anlaysis of cries, and their intonation in the 
pain from the application of fire, 863 of a cutting instrument^ 

86 3 of an acute affection not caused by an external agent, 

87 3 groaning, 87 j sudden fright, 87 j pains of labor, 87 3 sighs 
or tears, 88 j organs formed by the cries of animals, 88; 
anecdote related by Cahusac, 883 difficulty of explaining all 
the vocal inflexions, etc., 89. 



TABLE OF CONTENTS. Vll 

Aphony and Dys phony, 91-111 

definition and difference of these two vocal alterations, 91 3 
synoptical table of the organic lesions and diseases which 
may cause aphony and dysphony, 95 ; chronic enlargement 
of the tojisils, 98 3 organic prolongation of the uvula, and 
prolapsus of this organ, 105 ; its sensibility, 106 3 its infiltra- 
tion, 107 ; causes of this affection, 107 3 it may cause laryn- 
geal phthisis, 109. 

Chronic Inflammations of the Larynx and Trachea, 

and of Primitive Laryngeal Phthisis, 112-129 

A cold or slight bronchitis, its causes and treatment, 112 3 of 
acute and intense bronchitis, its causes and treatment, 
114 j chronic bronchitis, and its treatment, 117 3 who are 
most exposed to catarrhal affections, 118; chronic laryn- 
gitis and its medico-chirurgical treatment, 126. 

Sympathetic Aphony and Dysphony,.*.... 130-135 

What is understood by sympathies and sympathetic aphony, 
130 3 various facts proving the sympathy of the sexual 
organs with those of the voice, 131 3 treatment of the vocal 
alterations of this class, 133. 

Specific Aphony and Dysphony,... 136-155 

What is understood by specific, 136 3 what are specific affec- 
tions, 136 ; venereal aphony, 137 3 its symptoms and treat- 
ment, 138 3 scrofulous aphony, 142 3 difficulty of its diag- 
nosis, 144 3 its symptoms, 146 3 its treatment, 150 ; exanthe- 
matous aphony and dysphony, 151 ; their symptoms, 152 5 
their treatment, 152; chronic scorbutic aphony and dys- 
phony, 153 3 symptoms, 153 3 treatment, 154. 

Aphony and Dysphony symptomatic of other partic- 
ular Affbcti ons, 156-174 

Atonic aphony, 157 3 symptoms, 158 3 treatment, 159 3 compli- 
cations, 160 3 worm-aphony, 162 3 symptoms, 162 3 treat- 
ment, 163 3 nervous aphony and dysphony, 163 3 its causes, 
163} therapeutical measures, 164 5 case at the Hotel-Dieu, 
165 j relative aphony and dysphony, 166. 



Vlll TABLE OF CONTENTS. 

Hoarseness, or a Cold, 168-170 

Particular Modification of the Lartngo-pharyngean 

mucous Membrane, 171-174 

Sore Throat and Inflammations of the Pharynx,.... 175-190 

Coryza, or Cold in the Head, 190-194 

Gargles, 195-204 

Hygiene of the Voice, 205-320 



TRANSLATOR'S PREFACE. 



The voice has ever been the subject of 
most careful research and diligent examina- 
tion to physicians and physiologists, and 
theories innumerable, based only upon the 
vain imaginings of their promulgators, have 
been put forth to the world. Important at 
all times and seasons, as the means of com- 
munication from man to his fellows, the 
medium by which he expresses the most 
varied passions, the cheering companion of 
the family circle, and the mighty power by 
which multitudes are swayed to the will of 
one, the culture of the voice has within a 
short period begun to receive increased and 
systematic attention. From ignorance of its 
laws, many a talented speaker has been 
compelled, after a short period, to relinquish 



x translator's preface. 

the eminence he had already attained, and 
in some new, perhaps less favored path, 
attempt to exercise the same degree of in- 
fluence. 

Many professions require the most con- 
stant and fatiguing exercise of the vocal or- 
gans, for which a regular course of training 
should be gone through. Yet these very 
professions are entered upon by our young 
men, without once pausing to reflect, whether 
they can subject the voice to the arduous 
duties it may be called upon to perform, or 
whether the seeds of more fatal disease will 
not rather be sown, and they themselves 
numbered with the victims of consumption. 
Only by gradual efforts does the blacksmith 
at length gain strength to wield day by day 
so powerfully the heavy hammer, which our 
unaccustomed arms will scarce avail to raise 
from its situation even once. The same is 
true of all our organs ; they must by gradual 
practice be brought to their full powers. 
How preposterous, then, it is to dream, that 
the retirement of the closet, or the severest 
study can qualify a man in the use of his 



TRANSLATOR S PREFACE. XL 

voice for the pulpit, the bar, or the stage, 
immediately upon entering his professional 
career. 

The present translation was undertaken 
at the request of an eminent Professor of 
Elocution, with the hope, that it might prove 
useful to the general reader, by pointing out 
to him the physiology and diseases of the 
organs of the voice, the medical treatment 
of the more common of these affections, and 
the conditions necessary to preserve them in 
health. Such points, as related strictly to 
the surgical details, have been intentionally 
omitted, in order to render the work as com- 
pact as possible, and also because the sur- 
geon, whom these points alone concerns, will 
find them given at length in the surgical 
works of the day. In the course of the 
translation it has even seemed that there 
were some hints and suggestions, which 
might not be found altogether useless by the 
medical profession. 

Of the merits of the original work it will 
be sufficient to say, that to the author, Mons. 
Colombat de l'lsere, was awarded, by the 



Xll TRANSLATOR S PREFACE. 

Royal Academy of Sciences, the prize of 
five thousand francs, for his works upon the 
mechanism of pronunciation, and his success 
in the treatment of errors of speech, and 
particularly of stuttering. The favorable and 
probably unique situation, which he has 
occupied for many years, as founder and 
director of the Orthophonic Institution, at 
Paris, has afforded him such means of ob- 
servation upon this peculiar class of affec- 
tions, as have fallen to the lot of no other 
person. The translator, borrowing the 
modest language of the author, will only 
say of his own efforts, — " a subject of this 
nature requires a more skilful pen than 
mine, but in undertaking so difficult a task, 
I have consulted my own powers less than 
my desire to be useful : 

*Si desint vires, tamen laudanda voluntas. 1 *' 



THE VOICE. 



CHAPTER I. 

DESCRIPTION OF THE VOCAL INSTRUMENT. 

Art can never imitate the mechanism and 
sounds of the vocal instrument, and man will in 
vain seek to communicate to mechanical instru- 
ments the principles of the animal organization, 
because he will never have at his disposal the 
elements of vital action. 

The organs, which by their union contribute to 
form and modify the vocal sounds, are the fol- 
lowing : 1. The lungs, the reservoirs of the air; 
2. The muscles of respiration and the chest, 
which act like the bellows ; 3. The trachea and 
bronchi, constituting a windpipe bifurcated infe- 
riorly ; 4. The larynx proper, which acts as an 
elastic and movable mouthpiece ; 5. The glottis, 
1 



% THE VOICE. 

the vocal cords of which are well represented by 
the lips of a musician playing upon the horn; 
6. Finally, the pharynx or back part of the 
mouth, the veil of the palate, the uvula, the ton- 
sils, the epiglottis, the palatine arch, the nasal 
cavities, the maxillary sinuses, the lips, the 
cheeks, etc., equally contribute to the formation 
of the voice, and play an important part in the 
intensity and modulation of the sounds. 

To render this work complete, a detailed 
description of all the parts mentioned ought, per- 
haps, to be given ; but as I have nothing new to 
add with regard to their anatomy, and as such 
details would enlarge too much a work intended 
for the general reader, a few words with regard 
to the form and structure of the larynx are all 
that seem necessary to me. 

The larynx, from the Greek XagvyS, a whistle, 
the principal organ of the voice, is a kind of car- 
tilaginous box, v/hich, taken as a whole, has the 
general form of a hollow and reversed cone, with 
its base turned upwards towards the tongue in 
the shape of an expanded triangle opening into 
the pharynx, and its summit, united inferiorly to 
the trachea, is continuous with that canal by a 
rounded opening. 

The superior orifice of the larynx is an oval 



THE VOCAL INSTRUMENT. 




Fig. I.« 

space, bounded in front by the epiglottis, behind 

* The right wing of the thyroid cartilage has heen cut away in 
this plate, in order to expose the muscles connected with the edge 
of the glottis. No. 1. The large horn of the thyroid cartilage. 2. 
The interior surface of its left wing. 3. The surface of the incision 
made to remove the right wing. 4. The right arytenoid cartilage. 
5. Part of the arytenoid muscle. 6. The thyro-arytenoid muscle. 
7. The lateral crico-arytenoid muscle. 8. The posterior cricoaryte- 
noid muscle. 9. The right side of the cricoid cartilage. 10. The 
first ring of the trachea. 



4 THE VOICE. 

by the arytenoid cartilages, and upon the sides 
by the folds of the mucous membrane. This 
superior orifice of the larynx is always open, and 
passive as regards the formation of the voice and 
respiration.* 

The walls of the larynx are chiefly formed by 
the union of several cartilages, called the thyroid, 
arytenoid, cricoid, and the epiglottis, which is a 
jibro- cartilage. 




Fig. 2. 

The thyroid or scutiform cartilage, from the 
Greek <9-vQsog, a buckler, and sidos, form, is the 
largest of all the cartilages of the larynx. It 

* Those who have never seen, or who have badly studied the 
larynx, always confound the superior opening of this organ with 
the glottis, which is below. The name of epiglottis contributes to 
perpetuate this error, because the inference is that the epiglottis 
immediately covers the glottis. 



THE VOCAL INSTRUMENT. O 

forms the anterior wall of this organ, and the 
projection in the neck, which is called AdarrCs 
apple, marked 1 in the figure ; 2 indicates the 
square sides of this cartilage ; 3 its upper, and 4 
the smaller, horns. 




Fig. 3. 

The two arytenoid cartilages (2,) from the 
Greek aovzcuva, a ladle, and £idog,form, united 
by their anterior edges to the posterior borders of 
the preceding are situated at the posterior and 
superior part of the organ. 

The cricoid cartilage, (1, Fig. 3,) from the 
Greek v.qivog, a ring, and eidog,form, circular, 
as its name indicates, is situated at the inferior 
part of the larynx, and united by its superior 
borders, through the intervention of a membrane, 
to the inferior borders of the three cartilages just 
mentioned ; below, it corresponds to the first ring 
of the trachea of which it is a continuation. 
1* 



O THE VOICE. 

There now remain four cartilages, which are 
the two corniculated cartilages, called, also, the 
tubercles of Santorini, and the cuneiform or 
cartilages of Meckel ; but as these cartilages have 
been less studied, and as their functions are but 
little known, the mention of them will be suffi- 
cient. 

Finally, the epiglottis* a vigilant sentinel, is 
placed at the superior part of the larynx, and 
fixed to the upper border of the thyroid cartilage, 
behind the base of the tongue. It is a fibro-carti- 
lage ; its shape has been compared to that of a 
leaf of parsley ; its use is to prevent the introduc- 
tion of articles of food into the air-passages, and, 
probably, to modify the sounds as they issue from 
the glottis. 

From what has been said, it will be seen that 
the arytenoid cartilages are by their situation, at 
the posterior and superior part of the larynx, 
opposed to the thyroid, which forms the anterior 
and superior part of this organ. The connections 
maintained by these three cartilages with regard 
to each other, are of the highest importance in 
the formation of the vocal sound. In fact, two 
ligaments, formed of elastic and parallel fibres, 
enclosed in a fold of the mucous membrane, 

* Vide Frontispiece. 



THE VOCAL INSTRUMENT. 
35 




Fig. 4.* 

slender and about two lines in width, are inserted 
behind into an anterior projection at the base of 
the arytenoid cartilages, and passed forwards to 
be fixed in front to the middle of the angle on the 
interior of the thyroid. These two ligaments, 
which I call the lips of the larynx, were named 
by Ferrein the vocal cords, and are called by 

*In this plate is represented a view of the larynx from above, 
G E H the thyroid cartilage, enclosing the ring of the cricoid, r u x w, 
and turning upon the axis x z, passing through the lower horns, 
4, Fig 2;NF,NF, the arytenoid cartilages connected by the trans- 
verse arytenoid muscle ; T V, T V, the vocal ligaments ; N X, the 
right lateral crico-arytenoid ;vkf, the left thyro-arytenoid j N 1, N 1, 
the posterior cricoarytenoids j B B, the crico-arytenoid ligaments. 



8 THE VOICE. 

anatomists of the present day the inferior liga- 
ments of the glottis, or the thyro-arytenoidean. 
The interval between them forms the glottis, an 
oblong fissure, from ten to eleven lines in length 
in the adult male, and from two to three broad in 
its widest part, varying, however, and more con- 
siderable behind than before, where the two 
vocal cords approximate each other, so as to 
touch at the point of their insertion into the 
thyroid cartilage. 

These ligaments, covered by the fleshy fibres 
of the thy ro- arytenoid muscles, to which they 
adhere, and which they separate from the lateral 
crico-arytenoid muscles, are enveloped by the 
mucous membrane of the larynx through the 
remainder of their extent. Their superior face, 
directed outwardly, constitutes the lower wall of 
a depression named the ventricle of the larynx, 
the upper wall of which is formed by the superior 
ligaments of the vocal instrument, which are 
situated more externally, about the middle of the 
anterior face of the arytenoid cartilage. These 
ligaments, which are merely a fold of the mu- 
cous membrane of the larynx, are not fibrous, are 
less elastic than the inferior, and represent supe- 
riorly another kind of glottis, which is separated 
from the true glottis by the ventricular cavities 
just mentioned. 



THE VOCAL INSTRUMENT. y 

The larynx, as well as the trachea, is lined by 
a mucous membrane, but it is more sensitive 
than that of the trachea, and the contact of the 
smallest foreign body causes in it an excessive 
irritation, the severity of which strikingly con- 
trasts with the small extent and apparently slight 
importance of the organ. It is in consequence 
of these irritations, increased, too, by painful and 
prolonged movements in the exercise of certain 
professions, that we often meet with alterations, 
which, although but slightly visible in the autopsy, 
have occasioned such mournful results as even to 
have hastened the hour of death. 

The larynx is much more developed and 
prominent in man than in woman, in whom this 
organ has but two thirds and even the half of the 
volume of that of man. In the latter, the retreat- 
ing angle of the thyroid cartilage is acute, while 
it is rounded in woman, in whom the central 
slope of the superior border of the same cartilage 
is less deep, and the epiglottis less large, less 
thick, and less prominent than in man. 

Less striking differences are to be observed in 
the foetus and the infant ; only the larynx is not 
so much developed as it will be at a later period, 
proportionally in either sex, but especially in 
ours. It is very remarkable, that this increase is 



10 THE VOICE. 

not progressive, like that of the other organs, but, 
on the contrary, develops itself almost at once at 
the period of puberty, and the energy of its func- 
tions makes itself apparent at the same time with 
that of the generative organs. It is this rapid 
increase, corresponding with the change in the 
voice, which furnishes us with the most certain 
signs of puberty. After this period, the larynx 
experiences no remarkable change, its edges 
simply become more decidedly developed, its 
cartilages become hardened and in part ossified 
in old men, with the exception of the glottis, in 
which I am not aware that any rudiment of ossi- 
fication has ever been discovered. In eunuchs 
this organ is as small as in woman ; and the re- 
moval of the testicles at an early period, by 
arresting the development of the larynx, perpet- 
uates in males the clear and feminine voice of 
adolescence, and even destroys the timbre of that 
already formed, when the operation has been 
resorted to soon after the period of puberty. 

Finally, to terminate all these dry and lengthy 
anatomical details, I will add, that several mus- 
cles are inserted into the larynx. Some of these 
muscles are external, and intended to move the 
entire organ, as to lower or elevate it, to carry it 
backwards or forwards, or, finally, to hold it 
steady. The other muscles are internal, and 



THE VOCAL INSTRUMENT. 11 

have for their object to change the relation of its 
parts, as to enlarge or contract the glottis, to 
stretch and relax the vocal cords. The external 
muscles, which attach the larynx to the neighbor- 
ing parts, are, the ster no -thyroids, the constrictors 
of the pharynx, and all the muscles of the hyoid 
region, etc. The internal muscles, which impart 
all their motions to the cartilaginous pieces com- 
posing the organ, are, the crico -thyroids, the 
posterior crico- arytenoids, the lateral crico-ary- 
tenoids, the thyro- arytenoids, and the arytenoid, 
properly so called. I will add, also, that the 
larynx has several glands, the uses of which are 
but little known ; these glands are, the epiglottic, 
the arytenoid, and the thyroid. The functions 
of the latter, especially, are entirely unknown ; 
those of the others seem to be to secrete a mucus, 
which lubricates the larynx and the epiglottis, 
keeps them supple and movable, and prevents 
them from being irritated by the continual pas- 
sage of air during respiration, singing, and speak- 
ing. Lastly, the nerves of the larynx, which are 
two on each side, have been named laryngeal 
for the superior, and recurrent for the inferior. 
I shall close by saying that the division of these 
nerves causes aphony, or loss of the voice, with 
which we shall be occupied in a future chapter. 



CHAPTER II. 

THE VOICE AND ITS FORMATION. 

The voice, cpcovrj of the Greek, vox of the 
Latin, is an animal sound, living and articulate, 
of which the air is the material, the glottis the 
efficient cause ; finally, the determining cause of 
the voice is the necessity or state of the mind, to 
which its actual expression is to be referred. 

This faculty of animals, of making themselves 
heard at considerable distances, is one of the 
most beautiful attributes of living nature, for 
without it they would be condemned during life 
to the silence of death. 

Every animal has a voice peculiar to itself, 
and which is a kind of distinctive character of 
the species to which it belongs ; these great 
differences in the voice depend upon a peculiarity 
in the organization of the parts concerned in its 
formation. 

Vicq 6? Azir, in an excellent memorial upon 
the voice, remarks that the structure of the 



FORMATION OF THE VOICE. 13 

larynx is extremely simple in animals with a 
sonorous and agreeable voice, like the lark and 
the nightingale ; while the organ is very compli- 
cated in those with a strong and disagreeable 
voice, as hogs, monkeys, etc. It would seem as 
if nature had been at more trouble to enable the 
horse to neigh, and the ass to bray, than to render 
the voice of man capable of imparting to us the 
most melodious sounds. 

The voice presents remarkable differences 
depending upon the age. It is feeble and shrill 
in children, but grows strong at a later period ; 
in woman the vocal timbre changes much less 
than in man, and it almost always preserves the 
characteristics of infancy. Young animals have 
a shriller voice than those which have finished 
their growth. This is a general rule ; neverthe- 
less, calves are an exception, for it has always 
been observed, that they have a graver voice than 
bulls and oxen. The cause of this peculiarity is 
without doubt in the larynx of these animals, 
which is larger and more movable when they are 
young, but gradually contracts as they approach 
the termination of their youth. 

All organized beings, in whom the respiration 
is effected by the lungs, utter vocal sounds, be- 
cause they are all provided with a glottis and 
2 



14 THE VOICE. 

larynx.* But these organs present in all classes 
such multiplied varieties of form and structure, 
that it is not possible for us to point them out in 
this place. 

The mammiferse, birds and reptiles, are then 
the only animals provided with a true vocal in- 
strument, and which can consequently give utter- 
ance to a voice properly so called. For it is 
only necessary for this purpose that a certain 
quantity of air, accumulated in any receptacle 
whatever, be driven out with violence, and break 
against the edges of an orifice more or less 
narrow and sufficiently contracted. Fishes, 
which respire by the gills, cannot, for this reason, 
produce any vocal sound. The monotonous and 
insipid noises made by some insects, as certain 
grasshoppers, locusts, and most flies, must not be 
regarded as a true voice ; the noise produced by 
them does not come from the mouth, but is the 
result of the mechanical friction of certain elastic 
membranes put in rapid agitation. These sono- 
rous organs are sometimes the elytra and wings 
of the insects, sometimes a kind of membrane in 
the form of a drum, or, finally, a sort of scraping 

* The male duck has scarcely any voice, on account of a dilata- 
tion of tjie trachea, in which the expired air is swallowed up, 



FORMATION OF THE VOICE. 15 

produced by the movements of the posterior 
thighs, in the manner of the violin- bow. 

The vocal timbre can be changed and modified 
by the habits ; for instance, those engaged in 
noisy occupations, such as smiths, millers, etc., 
or those who inhabit, like sailors, the banks of 
the sea and great rivers, generally have a 
stronger voice, from the fact that being obliged 
in speaking almost always to cover noises often 
very intense, they exert more strongly their vocal 
organs. 

The voice of man is strong in proportion to 
the development of the larynx, and the capacity 
of the chest. For this reason the vocal timbre 
seems much weaker after a meal, because the 
stomach, distended by food, diminishes the 
capacity of the chest by crowding up the 
diaphragm superiorly. 

No sound goes more directly to the soul than 
the human voice ; therefore the instruments more 
nearly allied to it, such as the concert-horn, the 
bassoon, and the hautboy, have a more touching 
and melancholy expression, especially in the 
minor tones and solemn music. This organ, as 
admirable for its sweet harmony as for its great 
simplicity, is, I repeat, beyond all imitation, and 
not even the most skilful mechanic will ever 



16 THE VOICE. 

devise an instrument to produce sounds as beauti- 
ful, and furnish in the same degree of perfection 
this melodious timbre, these varied tones, and 
these inflexions so manifold and agreeable. 

The experiments of Ferrein, by means of 
which, as he himself said, he made the dead 
speak, are well known. The Dominican, Albert 
the Great, constructed a head, which, by peculiar 
mechanism, was enabled to pronounce some 
articulate sounds. The famous statue of Mem- 
non, which sung, upon the authority of Pliny 
and of Strabo, is not less wonderful, although it 
uttered only inarticulate sounds. The history of 
this prodigy may furnish an idea of the others, 
and show how far art has always been from 
nature. " The Egyptians, to perpetuate the 
memory of Memnon, had erected in his honor, in 
the temple of the god Apis, upon the borders of 
the river Belus, a statue which had this pecu- 
liarity, that being lighted and struck by the rays of 
the rising sun, it sent forth a sound as melodious 
as that of a lyre, while in the evening the sound 
was mournful and deep, which might have been 
a very natural effect of the dilatation and conden- 
sation of the air. A reed had undoubtedly been 
adapted to the mouth of the statue ; in the morn- 
ing the air, warmed by the rays of the sun, issued 



FORMATION OF THE VOICE. 17 

with a clear sound ; in the evening, when the 
sun retired, and the statue grew cold, the re- 
turning air caused a dull sound in its interior. 
In a word, the effect being external in the morn- 
ing, and internal in the evening, the variation in 
the sounds is naturally explained. " * 

Singing is a modification of the voice depend- 
ing upon the passions, and especially that of love ; 
this is the reason, perhaps, why at that interesting 
period of life, when we experience for the first 
time this thirst for love, nature develops in so 
rapid a manner the vocal organs, and changes 
almost at once the timbre of the voice. In the 
season of spring, when the birds are accustomed 
to choose their mates, the singing of the nightin- 
gale is in all its beauty, while in the month of 
June, when it has young, its voice is so disagree- 
able and so much changed, that it is con- 
temptible. 

Of all the actions peculiar to man, singing is 
the most familiar to him ; there are no people, 
even the least civilized, among whom singing is 
not practised. The savages of America, the 
CafTres, the Esquimaux, and the Greenlanders, 
experience, as well as the Europeans, the desire 
for singing. Rousseau is therefore in the wrong 

* Rouland. 

2* 



18 THE VOICE. 

when he says that singing is not natural to man ; 
and so, too, is that German author, Blumenlach, 
who has advanced the doctrine, that if whistling 
is peculiar to birds, singing belongs to man alone. 
These two opinions, which are paradoxes, are 
founded upon a puerile verbal distinction ; for 
singing does not require the application of words, 
these being but an explanation, of which the 
melody is the picture. It is, moreover, a com- 
mon fact that certain mutes, without uttering any 
articulated notes, can sing and modulate sounds 
almost as agreeably as those who speak.* 

To a delicate ear, the voice of the individual 
may teach many things with regard to his tem- 
perament, character, moral qualities and states 
of mind. It is certain, that the condition of the 
mind exerts a marked influence over the organ 
of the voice, which always varies according to 
circumstances. We may therefore say with 
Gretry, that if man can conceal himself in his 

* I have now under my care a young man. thirteen years of age, 
to whom, a year since, I restored the poWer of speech. When I 
had succeeded in teaching him to listen and to hear, although he 
could not then articulate a single word, he repeated accurately and 
in time, all the airs that I sang or played to him upon the horn 
or violin. I have also seen an old soldier, whose tongue had 
been completely removed by a bullet, who sung in an extremely 
agreeable manner, and modulated with much taste and talent the 
most difficult airs of the French and Italian operas. 



FORMATION OF THE VOICE. 19 

conversation, he has not yet learned to disguise 
his intonations. The immortal physiognomist of 
Switzerland, Lavater, said, that the voice and the 
countenance were very often associated. 

In a work of Father Kircher, we read, that 
a strong and hoarse voice is that of a man ava- 
ricious, pusillanimous, insolent in prosperity, 
cowardly in misfortune ; such was Caligula, ac- 
cording to Tacitus. The voice which is grave at 
first, and terminates in faucette,* is that of a sad 
and irritable scold ; the sharp, feeble j and broken 
voice is that of an effeminate ; that which is 
sharp and strong indicates a man devoted to 
pleasure ; finally, the same author adds, that the 
grave, sonorous, heavy and precipitated voice 
denotes an individual enterprising, bold, and 
adapted to the execution of great things. 

If the voice, in an ordinary condition of the 
mind, can discover to us the inclinations and 
moral qualities of the man, it will yet far more 
certainly expose the different passions with which 
he is agitated. Fear and languor lower the 
voice, astonishment cuts its off, admiration pro- 
longs it, hope renders it sonorous and equal, 
anger makes it hoarse and interrupted, desire 

* The reason will hereafter be given why this word should be 
written faucette, and not falsette. 



20 THE VOICE. 

hastens the words and causes the phrases to 
begin by long exclamations. Boldness renders 
the discourse laconical ; it always leaves some- 
thing for thought to supply : quos ego Iff... 
Plato knew so well that the sound of the voice 
could, to a certain point, discover the moral state 
of men, that when he wished to know those who 
addressed him for the first time, he said to them, 
Speak, that I may know you. 

The voice may also often instruct us in regard 
to the state of the body, on account of its admira- 
ble sympathetic relations with the nervous system 
in general, especially with the sexual parts. To 
this latter sympathy must be attributed the change 
of the voice, the faucette of eunuchs, the melo- 
dious singing of birds in the season of their loves, 
and, finally, the aphony (or loss of voice,) upon 
which we shall make some observations, arising 
in consequence of a chronic enlargement or 
acute inflammation of the testicles, and often, 
also, from a prolapsus of the womb, or a suppres- 
sion of the menses, and even from child-bearing. 

The sympathy of the voice with the whole 
nervous system is not less manifest ; in fact, in 
malignant fevers the voice presents a remarkable 
alteration; on the accession of acute diseases 
the patients often complain of pains in the throat, 



FORMATION OF THE VOICE. 21 

which, not being the result of any apparent 
inflammation, generally announce a grave affec- 
tion, frequently accompanied by nervous acci- 
dents. It is the same with all affections compli- 
cated with delirium, and with all other nervous 
diseases, such as insanity, the cholera, etc., which 
are ranked in this class by most physicians. 
Finally, the inconvenient spasm experienced in 
the throat by hysterical females and hypochon- 
driacal subjects, is a new proof in favor of this 
sympathy. 

In the warm seasons the voice is more beautiful 
and more sharp ; in winter, on the contrary, it is 
more grave and hoarse. It is probably owing to 
the influence of the temperature, that the people 
of the south have in general a finer and more 
sonorous voice than the inhabitants of the cold 
countries. Foreigners acknowledge, that in 
France are found the greatest number of fine 
voices ; how far is this to be ascribed to the de- 
velopment of the chest, which in that country has 
in general a better conformation ? * 

The idioms of the south, such as the Spanish 

* Nature, according to the Abbe Expili, develops more fully certain 
parts of the body in one climate than in another. He considers, 
that a man would be perfect in his physical development, who had 
the legs of a Spaniard, the hand of a German, the head of an Eng- 
lishman, the eyes of an Italian, the body, size, and gait of a French- 
man. 



22 THE VOICE. 

and Italian languages, the accents of which are 
more marked by the vocal inflexions and the 
frequent use of the vowels, are more favorable to 
music than the languages of the north, the pro- 
nunciation of which is very far from singing. 
In a language as harmonious as was anciently the 
Greek, there must have been without doubt very 
little difference between the speaking and the 
singing voice. 

If the same musical phrase were to be sung in 
words translated into the principal languages of 
Europe, the difference to the ear in harmony and 
sweetness would be very striking. The Italian 
and the Dutch languages, taken as the two ex- 
tremes of the comparison, would follow a pro- 
gressive course, in the following order : Italian, 
modern Greek, Portuguese, Spanish, French, 
German, English, Dutch. 

The people of the south greatly prefer the 
shrill voices ; those of temperate countries prefer 
the median ; finally, the inhabitants of the north- 
ern regions seem to give the preference to the 
base. The difference of climate probably exerts 
an influence over the taste of nations, as well as 
over the sweetness of the tongues. In Italy, the 
first male parts in the operas are filled by sopra- 
ni ; in France, by tenors ; in Germany, by base. 



FORMATION OF THE VOICE. 23 

The human voice is the most beautiful medium 
of execution possessed by the musical art. It 
will ever be in vain, therefore, for instruments to 
attempt to imitate it ; for, like slaves which pre- 
cede or follow their master, they have only been 
invented to accompany and sustain the voice. 

As each individual is distinguished from another 
by his physical features and form, so may he 
easily be by the nature and timbre of his voice. 
But there are some of these differences common 
to several persons, and which form so many dif- 
ferent kinds of voice, each of which has received 
a particular denomination. 

To carry the vocal system to the capacity of 
that of the great singers, which is often in three 
octaves, it has been agreed to divide it into six 
parts, which represent six kinds of voice : 

1st. The first above, first soprano. 

2d. The second above, second soprano. 

3d. The contralto. 

4th. The tenor. 

5th. The baritone. 

6th. The base. 

It is not then from the timbre and volume of 
the voices, but rather from their extent in the 
musical scale, that this general distinctive charac- 
ter has been devised. 



24 THE VOICE. 

The grave voice is not usually met with in 
man till after puberty ; while acute voices are 
more frequently met with in women, children, 
eunuchs, and in most men who take the faucette 
in singing. 

Voices are also known by other differences 
than those of the grave and acute. There are 
strong voices, in which the sounds are strong and 
brilliant; sweet voices, in which the sounds re- 
semble the tones of the flute ; extensive voices, 
those which run through a large musical scale ; 
beautiful voices, the timbre of which is full, just 
and harmonious. There is also the contrary of 
all this ; for example, we meet with harsh, hoarse, 
unequal voices, those in which the beautiful 
sounds are unequally distributed, whether in the 
first, the second, or the third octave. An even 
voice, on the contrary, is one, in which the timbre 
is always the same through its whole extent ; 
finally, the voices, which pass without a harsh 
transition from the grave to the acute, are des- 
ignated by the epithets of flexible and easily 
managed, — with unvarying sweetness and flexi- 
bility they run through all the modulations con- 
stituting musical and vocal harmony. 

It has never been well determined in what the 
articulated sounds differ from the modulated ; 



FORMATION OF THE VOICE. 25 

nevertheless, this difference could be perceived, 
even if there were wanting to the voice which 
forms the word merely that permanence of sounds, 
which constitutes the voice of the true singing. 
Besides, the true distinctive character of this 
latter species of voice is, to form harmonic and 
appreciable sounds, the unison of which may not 
only be taken and felt, but which may even be 
expressed by signs forming part of our system of 
music. In the spoken voice, on the other hand, 
the sounds are not sufficiently sustained to be 
appreciated, and the different inflexions, which 
separate them, present only inharmonic and im- 
measurable intervals. 

Physicians and physiologists ought therefore to 
study the voice of man under different aspects ; 
they ought to study it, 1st, as a simple sound, 
such as the cry of infants, comprising in it the 
various intonations arising from the movements 
of the mind, the passions, pleasure, pain, disdain, 
anger, etc., etc. ; 2d, as an articulated sound, 
such as it is in ordinary conversation ; 3d, as a 
modulated sound, in singing, which adds to speech 
the variations in its tones ; 4th, finally, in decla- 
mation, which is, at the same time, a modification 
of the modulated and of the spoken voice, since 
it may be united to either, or withdrawn from 



26 THE VOICE. 

them. We shall examine the human voice in 
these four aspects, after having been occupied 
with its formation and the various opinions which 
have been promulgated as to its mechanism. 

For beings capable of experiencing sensations, 
it was not sufficient to have organs to transport 
themselves from place to place, and a volition to 
seek the things necessary for their life and the 
well-being of the individual. It was not enough 
for them to be able to select what pleased, refuse 
what disgusted, and avoid what menaced or might 
injure ; it was necessary to render them capable 
of communicating with their like at considerable 
distances, and to establish between them relations 
of a more elevated order. There was wanting a 
voice, which could express their pain or fear, 
their hatred or sympathy, their pleasures, loves, 
joys or desires. Man alone, capable of thought 
and abstraction, has received from nature the 
noble privilege of modifying his voice in articu- 
late sounds, which constitute speech. 

But this voice, — by what mechanism is it 
formed ? This we shall seek to explain in the 
following chapter. 



CHAPTER III. 

MECHANISM OF THE VOICE, ACCORDING TO THE 
OPINIONS OF BOTH ANCIENT AND MODERN 
PHYSICIANS AND PHYSIOLOGISTS. 

" The voice is not a simple vibration ; it is animalized ; it is liv- 
ing, like the organs which produce it." 

J. Bonnefox, Treatise on Phthisis, p. 122. 

From the remotest antiquity the formation of 
the voice has engaged the attention of physiolo- 
gists ; but unfortunately for science this question 
yet leaves much to be desired, and will perhaps 
always remain undecided on certain points. 

Before exposing my own opinions upon the 
production of the vocal sounds, and the part 
which, I think, each portion of the vocal appara- 
tus takes in their formation, I must first warn my 
readers, that although I may have a great number 
of facts to add, yet I am very far from hoping to 
derive any personal fame from the treatment of 
so difficult a subject, after the distinguished men 
and authors, whom I shall mention. 



28 THE VOICE. 

A great number of theories have been in turn 
proposed to explain the formation of the voice ; 
before examining them, briefly indeed, I wish the 
reader to call to mind the way in which the ex- 
pired air traverses the larynx, when the internal 
muscles of the glottis are in a state of contraction. 

At first, the air, which inspiration has intro- 
duced into the lungs, is driven out from their 
cavities into the larynx by the movement of ex- 
piration and the play of the muscles of the chest. 
This is the first act necessary for the production 
of the voice, for it is during expiration that the 
vocal sounds are produced. Several authors 
think that it takes place during inspiration ; I 
have myself seen stutterers who spoke smoothly 
sometimes during inspiration, because they articu- 
lated more easily in this manner, although the 
timbre of their «voices was very much altered. 
Dodart relates the case of a man, who was tor- 
mented by a constant cough, and only spoke 
during inspiration ; Adrian Tournebozuf and Hal- 
ler also cite several examples of it ; I have myself 
the power to run through a gamut with sufficient 
accuracy during a long inspiration, but this gamut 
only begins at do below the first line and finishes 
at do in the octave, in the middle of the scale of 
five lines. Notwithstanding the facts first cited, 



MECHANISM OF THE VOICE. 29 

there can be no doubt that the formation of the 
voice is an expiratory phenomenon ; and that 
when the production of the vocal sounds takes 
place during inspiration, it is by an unusual 
mechanism, which acts irf the inverse order to 
that which is natural. 

The labors of modern physiologists leave no 
longer any uncertainty as to the organ which 
generates the voice, and permit the certain 
answer, that among the parts which give passage 
to the expired air the larynx forms the voice ; 
also, that of the several pieces composing the 
latter, the glottis is the organ essentially phonetic. 
As there is now no doubt of this, I will not in this 
place recapitulate the several arguments in favor 
of this proposition, which is completely beyond 
refutation. 

If this question admits of being readily answer- 
ed, it is not the same with that which relates to 
the different mechanisms of the formation of the 
voice, and to what order of instrument the vocal 
organ should be referred. Before replying to 
this question, I will first rapidly examine the 
different theories already promulgated. Among 
the principal are the following : 

Aristotle and Galen compared the larynx to a 
3 # 



30 THE VOICE. 

flute, and regarded the trachea as the body of the 
instrument. 

In the sixteenth century, the celebrated Hiero- 
nimus Fabricius, so improperly designated as 
Fabricius of Aquapendente, and his pupil Cas- 
serius of Placentia, admitted all the opinions of 
Galen and Aristotle, but they maintained, with 
reason, that the trachea was merely a windpipe. 

In 1700, Dodart compared the organ of the 
voice to a horn or trumpet ; according to him the 
glottis is the point which answers to the lips of 
the musician ; the body of the instrument extends 
from the glottis to the external orifice of the 
vocal canal, the mouth. This theory, well re- 
ceived at the time, and admitted, to borrow the 
expression of Haller, magno cum plausu, has for 
a long time been entirely abandoned. 

In 1742, Ferrein declared, that the larynx was 
an instrument with strings, and compared it to a 
violin. This opinion made much noise at the 
time, and received an almost general consent, 
which it was very far from deserving. This 
observer compared the ligaments of the glottis to 
the cords of a violin, and gave them the name of 
vocal cords. The current of air was the bow ; 
the thyroid cartilages the fixed points ; the aryte- 
noid the pegs ; and, finally, the muscles inserted 



MECHANISM OF THE VOICE. 31 

into them were the powers intended to stretch or 
relax the cords. Such a theory is very far from 
being correct, because the cords, to vibrate and 
produce sounds, must combine certain conditions, 
such as dryness, fixedness upon a sonorous body, 
liberty, elasticity, a sufficient tension, a certain 
length, and finally a certain consistence. None 
of these conditions being met with in the pretend- 
ed vocal cords, physiologists, and especially mod- 
ern physicians, have had reason to reject the 
theory of Ferrein, and to cease to regard the 
larynx as an instrument with strings. 

The immortal Bichat, that great genius re- 
moved at so youthful an age from science, after 
having made a long series of ingenious experi- 
ments, almost all verified and confirmed at a later 
period by Magendie, could not come to any posi- 
tive deduction, and contented himself with saying, 
that the harmonic gradation of the vocal sounds 
would yet be for a long time an object of research, 
and that a problem so difficult would perhaps 
never be resolved in an indisputable manner. 

Professor Richerand maintains the safe medium 
in the opinions already put forth ; for he considers 
the larynx as, at the same time, both a string and 
wind instrument. 

The modem Buffon, the eloquent and profound 



32 THE VOICE. 

naturalist, whom a sudden and unexpected death 
has just removed from science and from arts — the 
learned Cuvier — ranked the vocal organ in the 
class of flutes, and regarded the glottis as the 
reed of the instrument, the mouth as the body, 
and the nostrils as the lateral holes. 

In 1806, M. Dutrochet maintained in his 
inaugural dissertation, that the production of the 
voice was an active phenomenon depending upon 
the vibration of the fibres forming the thyroaryte- 
noid muscles; the vocal pipe is supposed by him 
to have no influence over the production of 
tones ; the larynx is called a vibrating instru- 
ment, but not complicated with a pipe. 

Magendie, one of our most illustrious physi- 
ologists, who has given to the larynx the name of 
the human reed, thinks with Biot, that this organ 
should be compared to our reed-instruments, such 
as the hautboy, the bassoon, etc. 

Savard, who has published some very re- 
markable works upon the formation of the voice, 
has compared the larynx to a kind of whistle, a 
short instrument pierced at each end by a small 
orifice, and used by huntsmen to imitate the cry 
of birds. He has consequently established, that 
the ligaments of the glottis and the ventricles, 
which open between them, take an essential part 



MECHANISM OF THE VOICE. 33 

in the primitive formation of the vocal sounds. 
The air, traversing the glottis, strikes upon the 
superior ligaments ; the latter bind the superior 
opening of the instrument, and discharge the 
same function as the stop of an organ-pipe. 
Then the air contained in the larynx vibrates and 
gives out a sound which increases in intensity, 
because the sonorous waves which form it, are 
prolonged into the pharynx, the cavity of the 
mouth, and the nasal fossal. It is evident that 
the author of this system seeks to account for the 
uses of the ventricles of the larynx and for that 
of the superior ligaments, of which no mention is 
made in the other theories. I do not know how 
far this theory may correspond with that of na- 
ture ; although it has appeared to me more 
rational than any other, I have not been able to 
admit it completely for several reasons. In the 
numerous autopsies, that I have made, for the 
purpose of studying the anatomy of the larynx, I 
have sometimes found this organ destitute of 
ventricles and of superior ligaments in individ- 
uals, among whom there were several, who in 
life had a fine vocal timbre. One fact which, I 
think, goes to prove that the superior ligaments 
and the ventricles do not play so important a part 
as that assigned them by M. Savard, is, that if 



34 THEVOICE. 

they are divided in a dog, or merely cauterised 
to prevent their action, the voice of the animal is 
not altered, or at any rate is not altered or de- 
stroyed, unless the incision or cauterisation be 
prolonged downwards quite to the inferior liga- 
ments, which form the true glottis. 

M. Despinay, of Bourg, in his researches upon 
the voice says, that the sounds, formed in the 
glottis, undergo in this opening great variations ; 
to pass outward, they escape by the pharynx, a 
muscular canal, capable of undergoing numerous 
changes, and also of modifying these sounds ; 
this canal, may be compared, from its influence, 
to the movable tube of a trombone. In this in- 
strument the sound is formed at the mouthpiece ; 
the different degrees of opening of the lips cer- 
tainly serve to produce changes in the intonations ; 
they are, in this respect, what the glottis is to the 
voice ; but no one will deny but that the 
lengthening or shortening of the instrument oc- 
casions very different notes. The pharynx acts 
in the same manner upon the voice ; it is elon- 
gated by the contraction of the ster no -thyroid, 
sterno-hyoids, omo-hyoids, and is diminished in 
extent by the influence of the mylo-hyoid, genio- 
hyoid, and other muscles. Nevertheless, if the 
larynx were invariably fixed, it alone would be 



MECHANISM OF THE VOICE. 35 

capable of giving out the grave tones, as well as 
the acute and intermediate. 

This theory of vocal mechanism, which greatly 
resembles that which was adopted by me, and 
pronounced the most rational, when, in 1828, I 
published my work upon stuttering ; this mechan- 
ism, I repeat, is no longer considered by me as 
approximating the closest to nature. But before 
making known my own opinions in this respect, 
I wish to endeavor to refute those of M. Despinay, 
and the others which I have mentioned ; yet, to 
proceed with more method, it seems best to give 
a rapid sketch of the theory which is found in the 
second edition of my work on Orthophony. 
This theory is nearly that of M. Despinay, as the 
reader will hereafter perceive. In order to ap- 
preciate the analogy, which seems to me to 
exist between the vocal apparatus and a trom- 
bone, I shall say a few words about the latter in- 
strument. 

The trombone is an instrument having for its 
principal pieces a mouthpiece ; a tube which is 
made to vary in length by the musician ; finally, 
an expansion at the inferior opening, in the form 
of a tunnel more or less considerable in size. 
To draw sounds from this instrument, air must 
be driven into its interior by applying the lips 
upon its mouthpiece, the orifice of which is more 



36 THE VOICE. 

or less diminished, while, at the same time, the 
tube which constitutes its body, is lengthened 
or shortened, according as the sounds required 
are to be grave or acute. 

From this description of the trombone, the 
relation between this instrument and the vocal 
apparatus will readily be seen. In fact, do 
not the ventricles of the larynx, which comprise 
the entire space bounded inferiorly by the vocal 
cords, and superiorly by the superior ligaments 
of the glottis, closely resemble the mouthpiece of 
the instrument ? the lips of the glottis, are they 
not the lips of the musician ? the back of the 
mouth, may it not be regarded as the movable 
pipe of the trombone, and to be shortened or 
lengthened, like the latter, so as to depress or 
increase the sounds? finally, may not the tongue 
and epiglottis be considered as supplying the 
place of the hand of a player upon the horn 
which modulates, softens, or changes the sounds 
at will ? Moreover, the air driven out from the 
lungs, and carried by the trachea into the larynx, 
does it not comply with all the conditions re- 
quired for vibration and the production of sounds, 
as in all instruments with a reed or mouthpiece ? 
Do we not, also, know from the experiments of 
the friar Mercene, and from those of Euler, that 



MECHANISM OF THE VOICE. 37 

of whatever material the pipes of an organ are 
composed, the sound will always be the same, 
and equally strong and harmonious, if the internal 
capacity of these pipes does not vary ? This 
theory seemed to me the most natural, because 
by it could be explained the elevation and de- 
pression of the larynx, corresponding with the 
enlargement and contraction of the glottis for the 
emission of the vocal sounds, grave in the first 
case, and acute in the second. This theory, 
formerly my own, has been abandoned, because I 
have convinced myself, and shall show by facts 
hereafter, that the displacements of the larynx 
are not indispensable for the formation of sounds, 
but that their object is merely to facilitate the 
contractions and relaxations of the glottis. I shall 
soon endeavor to demonstrate this latter proposi- 
tion, by combatting the theory which compares 
the mechanism of the voice to that of the trom- 
bone. 

Among the ancient and modern authors who 
have written upon the voice, may be cited the 
following: Ethmuler, Fernel, Vesale, Wesel, 
Gunz, Perault, Conrad-Aman, Vic d'Azir, Roger, 
Haller, Helivalg, Caldani, Spallanzani, J. Frank, 
Mayer, Leuhossec, Gockel, Lefebure, Portal, 
Rampont, Geoffroy-Saint-Hilaire, Serres, Biot, 
4 



38 THE VOICE. 

Papillon, Liscowius, Cagniard-de Latour, Grenie, 
Meckel, Piori, Gerdi, Malgaigne, Deliau, Bour- 
don, Bennati ; finally, a great number of other 
physiologists, who have put forth opinions so 
numerous, and often so opposite, that if they were 
to be collected, it would require several volumes 
to contain them. As nearly all these opinions 
may be resolved into three principal, which con- 
sist, either in regarding the organ of the voice as 
a wind instrument with mouth and mouthpiece, 
as those of the class of flutes or trumpets ; or by 
comparing this organ to a reed instrument ; or, 
finally, to a stringed instrument, or, at the same 
time, to a wind and stringed instrument, — I deem 
it my duty to examine all these theories in gen- 
eral and in particular, before expressing my 
own opinions upon a question of physiology, so 
much the more difficult, as it never has been, 
and perhaps never will be settled in an incontest- 
able manner. 

The theory which compares the mechanism of 
the voice to that of reed instruments, where the 
sound is produced and modified by elastic plates, 
as in the hautboy, the bassoon, etc. ; this theory, 
which has been well discussed, especially by M. 
Savart, is not, in my opinion, correct ; and the 
reasons which have prevented me from adopting 



MECHANISM OF THE VOICE. 39 

it, are the following : In the ordinary instruments, 
to raise and depress the tones, the reeds are 
shortened or lengthened in the longitudinal direc- 
tion ; while to produce the same effect in the 
larynx, the vocal cords are stretched or relaxed 
in the direction of their width. In musical in- 
struments it never happens, as in the ligaments 
of the glottis, that the movable plates composing 
the reeds vary every instant in thickness, length, 
and elasticity ; moreover, these plates are com- 
posed of rectilinear fibres fixed at one side only 
and free at the three others ; while the plates or 
vocal cords of the larynx are fixed on three sides 
and free at one only, and form by their union a 
kind of curved sphincter, the fibres of which 
never present a straight line, except when the 
lips of the glottis are forcibly applied against 
each other. They then close the trachea so 
hermetically, that not a particle of air can escape 
from the lungs, notwithstanding all the efforts of 
the respiratory muscles. Finally, it has been 
impossible for me to admit that fleshy parts, soft, 
moist, covered by a mucous membrane constantly 
lubricated by mucosities, adherent in three ways> 
and filling none of the conditions that a reed 
should have, could furnish, by the same mechan- 
ism as the latter, sounds as strong, as varied, as 



40 THE VOICE. 

harmonious, and as beautiful, as those of the 
human voice. 

From these considerations, I think with the 
learned physician, M. Savart, that the voice is not 
produced by the mechanism of reeds, and that 
this theory is no more worthy to be adopted than 
that of the cords, proposed by Ferrein, which has 
already been discussed. 

It remains for me to speak of that theory which 
compares the vocal organ to the instruments of 
the class of flutes and horns, etc., and those fur- 
nished with a movable tube, such as the trom- 
bone, or, in other words, those in which the 
column of air is the vibrating body. This 
theory, which was that of Fabricius, of Aqua- 
pendente, and of Casserius, and which has been 
modified by several modern physiologists, among 
others by Cuvier, Despiney, etc., may be com- 
batted, because the air is regarded as the vibrat- 
ing body, but only under that of the too great 
part which, in the other theories, the depression 
and elevation of the larynx are made to take in 
the formation of the voice. In fact, those who 
regard the larynx as a wind instrument, especial- 
ly those who compare the vocal apparatus to a 
trombone, as I have for a long time been in the 
habit of doing, say in support of their opinion, 



MECHANISM OF THE VOICE. 41 

that in this instrument, and all others in which 
the air is -the vibrating body, the tones become 
more acute in proportion to the shortening of the 
tube ; in the same way, the elevation of the 
larynx lengthens the pipe, and the tones are pro- 
portionally changed ; they also add, that the tones 
are lowered just as the tube is elongated, and that 
the larynx descends in the same manner to pro- 
duce the low tones. Although these movements 
of the larynx are evident and indubitable, we 
shall endeavor to show that they are but acces- 
sory phenomena in the emission of tones, and 
that the variations in capacity, of which the pipe 
is capable, do not determine of themselves the 
different degrees of elevation of the voice, but 
are rather intended to correspond to the state of 
the glottis in the production of sounds more or 
less grave. Professor Meckel is nearly of this 
latter opinion, when he says: "With regard to 
phonation, the larynx ascends in the elevated 
tones, as much to separate the thyroid cartilage 
from the cricoid, and, at the same time, stretch 
its ligaments, as to elongate and fix the trachea. 
In the low tones, on the contrary, it is depressed 
to produce the opposite changes." 

A fact, which I have very often observed, and 

which any one can repeat, is, that it is possible* 
4* 



42 THE VOICE. 

with a little attention, so to fix the larynx, that, 
after having taken the most acute note of the 
voice, a transition may suddenly be made to the 
gravest possible note, not by depressing and re- 
laxing the vocal instrument, but, on the contrary, 
by contracting yet more strongly all the muscles 
of the vocal apparatus, so as to cause the larynx 
to ascend yet higher* By a similar mechanism, 
which has not yet been observed, or, rather, 
described, Ivanojf, the Russian singer attached to 
the Italian theatre at Paris, has succeeded in 
reaching the lowest sol. We shall in this place 
introduce the curious observation with regard to 
this excellent singer, made by our friend, Dr. 
Bennati, physician of the Italian theatre, who has 
published some highly esteemed works upon the 
present subject. The words of this observation 
may be found in a treatise presented to the 
Academy of Sciences by the physician already 
mentioned ; they are as follows : 

" M. IvanofT, aged twenty-three years, Russian 
by birth, tenor-contralto to the Italian theatre, can 
reach, with a voice of peculiar depth, the lowest 
sol ; that is, an octave below the voices of ordinary 

* The sound which results from this mechanism is not pure j it is 
a fictitious voice, and has a hoarseness. With a little exercise, any 
one may create for himself a third scale, as the Russian singer 
Ivanoff has done. 



MECHANISM OF THE VOICE. 43 

base singers. The timbre of his voice has, dur- 
ing the emission of this note, a hoarseness, or a 
fictitious voice which resembles that of ventrilo- 
quists, and which I can myself closely imitate 
during inspiration; but, in my own case, the 
mechanism of the vocal organs takes place in the 
usual manner, while in M. IvanofF the movement 
of the larynx and of the hyoid bone has an en- 
tirely opposite direction.* 

" These are my observations . upon him. Dur- 
ing the emission of the grave sounds, the larynx 
is situated anteriorly and superiorly, as takes 
place in the emission of the ordinary acute 
sounds, which prevents the position of the supe- 
rior edges of the thyroid cartilage from being 
verified ; the genio-glossal, hyo-glossal, genio- 
hyoid muscles, etc., as well as those of the jaws, 
are greatly contracted. 

" It is to be remarked, that during the emission 
of the sounds belonging to the natural diapason 
of the tenor-contralto Ivanoff, the mechanism is 
the same with that which ordinarily takes place. 

*I am astonished that M. Bennati, who has made a special study 
of the vocal organs, has never remarked, that all those who would 
exceed the limits of their voices, whether in grave or acute notes, 
present the same phenomena, the mechanism of which is produced 
by the great efforts and the contractions made to exceed the ordi- 
nary extent of the voice. This fact, presented as an anomaly, is 
merely a natural thing with every man. 



44 THE VOICE. 

Thus, for example, from do grave to do acute 
above the lines, the mechanism of the voice is 
effected in the natural way ; but when M. Ivanoff 
would go below the sounds indicated, which it is 
impossible for him to do for the entire extent of 
an octave, then the phenomenon in question takes 
place." 

M. Bennati adds, " When we consider that this 
singer belonged to the chapel of the emperor of 
Russia, which is composed in general of very 
remarkable base voices, with regard to the timbre 
and gravity of their sounds, and several of its 
members sing to the octave of ordinary base 
singers, forming a harmony truly admirable, may 
we not suppose that the imitative efforts, made 
by M. Ivanoff in the earlier years of his life, have 
gone far towards the production of the anomaly 
now described ? " I am entirely of the opinion 
of M. Bennati in this respect, and I think, as it is 
always the ear w T hich forms the voice, that, in 
order to imitate the Russian singers, M. Ivanoff 
made such great efforts as to oblige him to con- 
tract all the muscles of the pharynx, and of the 
veil of the palate, as if he had wished to give an 
acute note from the faucette. When the larynx 
had attained its last point of forced elevation, the 
vocal cords were relaxed, and the glottis opened 



MECHANISM OF THE VOICE. 45 

still farther than in the greatest depression of the 
larynx. This is not a theory ; it is a fact that 
any one may observe upon himself. I do not 
seek to explain it, but to verify and prove that 
the movements of the larynx are but movements 
accessory to the formation of the tones, and in- 
tended to facilitate the play of the parts which 
contribute to stretch or relax the vocal cords. In 
fact, when the sterno-thyroid muscle contracts to 
depress the larynx, it opens and dilates by its 
contraction the thyroid cartilage, which contrib- 
utes to the production of the grave sounds by 
the dilatation of the glottis. In the same manner 
the inferior constrictor of the pharynx, which, 
with the thyroid muscle, concurs to the elevation 
of the vocal instrument, contracts the thyroid 
cartilage, the plates of which it embraces ; these 
plates of the thyroid cartilage approximate the 
lips of the glottis, by pressing the lateral crico- 
arytenoid and thyro-arytenoid muscles. By con- 
tributing to the approximation of the lips of the 
glottis, the inferior constrictor of the pharynx 
concurs to the production of the acute sounds, 
but if the larynx were immovably fixed, the 
greater or less contraction or relaxation of the 
glottis would alone produce all the tones of the 
human voice. 



46 THE VOICE. 

It is easy to perceive from these observations, 
that I am not of the opinion of those physiologists 
who assert, that the variations in capacity and 
length of the vocal pipe exert a great influence 
over the production of sounds. I am far from 
believing that these variations are of no avail in 
the emission of the voice ; I am simply of opin- 
ion that their influence is generally exerted only 
upon the timbre and force of the sounds, but that 
they have no participation in the production of 
the tones, which, as I shall endeavor to show, are 
entirely formed by the glottis. In fact, the 
length of the vocal canal does not vary sufficient- 
ly to account for the numerous and varied tones 
produced by the human voice, and which some- 
times embrace three octaves or forty-eight semi- 
tones ; the larynx, which can, under ordinary 
circumstances, only be displaced an inch, conse- 
quently shortens the vocal tube only a fifth, 
which would give merely the tierce major below 
the first tone, and not the double or triple octave. 
Cuvier said, that these acute octaves were only the 
harmonies of the low octaves ; to admit this 
opinion, it is necessary, which is contrary to the 
fact, that the larynx should not have changed its 
position to produce the acute notes. Neither can 
the movements of the lips and of the tongue 



MECHANISM OF THE VOICE. 47 

cause any variation in the tones of the voice ; for 
articulated singing would be very difficult, and 
would require for its production the larynx to 
change its place with every different syllable. 
Moreover, by shutting the mouth the tone should 
be changed ; nevertheless, it is not so, and the 
sound only is modified by becoming more dull. 
Finally, by stopping the nostrils, and adapting to 
the orifice of the mouth a long tube, and even a 
common ear-trumpet, the gravity of the sound 
ought to be augmented, while it is merely ren- 
dered more sonorous and intense. The result of 
all these considerations was, that I was naturally 
led to doubt the assertions of physiologists, who 
contradict each other very often, and could not 
conceive why they have always had such a rage 
to compare the mechanism of the larynx to that 
of the different musical instruments ; it seems to 
me, on the contrary, that it would be more 
natural to compare these latter to the larynx, 
which is the most ancient and harmonious of all 
instruments. I say, then, that the larynx resem- 
bles nothing but a larynx, and that the admirable 
organ of the voice is a wind instrument, sui 
generis, inimitable by art, and the living mechan- 
ism of which cannot be compared to that of any 
other, because the principles of the animal 



48 THE VOICE. 

organization can never be communicated to a 
mechanical instrument, and because man will 
never have at his disposal the elements of vital 
action. 

But, I shall be asked, since you do not admit 
the theories of physiologists, what explanation 
will you give of the formation of the voice ? 

First, I shall reply, that I do not pretend to 
give explanations more mathematical than other 
persons, but simply that the glottis is the instru- 
ment that produces the sounds, or rather it is the 
air driven out from the lungs, which, under the 
influence of the will, by breaking against the lips 
of the glottis, produces sonorous undulations, 
modified by the pharynx, the tongue, the lips, the 
nasal fossal ; finally, by the entire vocal appara- 
tus. I think the formation of the vocal sound 
can be conceived of without having need of 
sonorous cords or vibrating reeds, and the pro- 
duction of the voice and its different modifica- 
tions may, indeed, be the result of a Jarge or 
small opening of the glottis, caused by the con- 
tractions or relaxation of its lips. Every body 
knows, too, that the constriction alone of the lips 
expresses, by whistling, varied and even harmo- 
nious sounds ; and that the air and different gases 
may be expelled from the body of animals with 



MECHANISM OF THE VOICE. 49 

certain modulations from openings, where, so far 
as I know, the existence of a reed or of vocal 
cords has never been suspected. 

The oscillations of which the lips are the seat 
in playing upon the horn, may equally aid us to 
prove that the muscular edges of an animated 
opening can vibrate in consequence of the con- 
tractions to which these edges are liable, especial- 
ly when these vibrations are excited by a current 
of air which alone is the material and the pro- 
ducer of the sound. I shall, perhaps, be asked, 
if I do not admit the vibrations of the glottis as 
productive of the vocal sounds, how I will ex- 
plain the vibrations of the thyro-arytenoid mus- 
cles which are felt by carrying the hand to that 
projecting and external part of a thyroid carti- 
lage, vulgarly called AdairCs apple ; they will 
also probably tell me that since nature has willed 
these vibrations to take place they must neces- 
sarily have a useful object. 

To answer, at the same time, these two objec- 
tions, I will say that it is the air which, by its 
more or less rapid passage across the glottis, puts 
the vocal cords in vibration, as in speaking it 
causes to vibrate all the other parts of the vocal 
apparatus, especially the nasal cavities and their 
5 



50 THE VOICE. 

cartilages.* These vibrations of the glottis and 
of the other vocal organs impart to the voice, by 
successively lengthening and shortening the mus- 
cular fibres, the kinds of sonorous undulations 
which render it more sweet and harmonious, and 
which give it a flute-like sound, similar to that 
drawn by our celebrated violinists from their in- 
struments, in consequence of a sort of trembling 
that they communicate to the cords by varying 
the pressure of the end of the finger upon them. 

The mechanism of the vocal instrument, al- 
though still shrouded by an impenetrable veil, 
may then be understood, as I conceive it, with- 
out being obliged to compare it to the other 
musical instruments ; besides, these instruments 
which have been created only to imitate or sus- 
tain the human voice, are not only very far from 
having sounds as melodious and as beautiful, but 
also from uniting in the same degree of perfec- 
tion the conditions most favorable for the pro- 
duction of sounds, whether we regard the timbre 
or the harmony. It is probably for this reason 
that the instruments which approach the nearest 
to the human voice have a more touching ex- 

* Any one can satisfy himself of these vibrations, by placing his 
fingers upon the wings of his nose, they will thus be rendered very 
apparent. 



MECHANISM OF THE VOICE. 51 

prcssion and go more directly to the soul,* and 
art will never succeed as well as nature in the 
production of an organ admirable for its great sim- 
plicity, and animated by a principle which, with- 
out doubt, will always be unknown, The vocal 
organ is, then, the most beautiful instrument ; 
since man can, by exercise, master at will his 
voice according to the rules of taste and har- 
mony, and produce those enchanting sounds 
which excite in us the purest pleasures and the 
most delicate sensations. 

I must, however, acknowledge, that those who 
make researches upon this material, will rarely 
agree together, since the organ of the human 
voice does not produce in the same manner all 
the tones belonging to it. The sonorous voice of 
singing and speaking, which in a theatre may be 
heard by two thousand persons at the same time ; 
the low voice with which we sing in a closed 
apartment ; finally, this acute voice which has 
received in our language the name of falsette ; 
all these voices must depend upon different 
mechanism, which will be examined by us in the 
following chapter. 

* There is nothing in this world more terrifying than the cries of 
a man in great danger. Each time that I have heard these horrible 
cries, they have remained for a long time in my heart. 



CHAPTER IV. 

THE FAUCETTE, OR PHARYNGEAN VOICE. 

From what has already been said it will be 
seen, that we have sought to demonstrate, that the 
glottis was the organ essentially concerned in the 
formation of the voice, and that the various 
alterations, of which the vocal tube is capable, 
were not intended to render the sounds more or 
less acute, but simply to render them more or less 
intense, and more or less clear, according to the 
form taken by the tube. But if in the greatest 
extent of the musical scale, the glottis is the 
organ generating the sounds, it is not so, in our 
opinion, when the larynx has reached its highest 
point of ascension ; then the diapason of the 
natural voice is carried beyond its capacity, and 
the singer is obliged to have recourse to another 
kind of voice depending upon a peculiar mechan- 
ism. The point of departure of this new series 
of tones is fixed after the last note of the first 
register ; that is, at the first note of the second, 



THE FAUCETTE VOICE. 53 

and may. often be carried to the octave of this 
note in some individuals. 

To the union of the sounds constituting this 
second register has been given the name of voice 
of the head or falsette* to distinguish it from the 
voice of the chest or of the first register, which we 
call the laryngean voice, as being formed by the 
larynx alone. But, I shall be asked, if you 
admit a new mechanism for the formation of the 
sounds in high singing, that is, when the larynx 
is carried to the highest possible point, what 
organ participates the most in it ? In reply to 
this question I will say, that the acute notes de- 
pending on what is called the faucette, arise from 
the almost exclusive employment, or rather from 
the forced contraction of the superior part of the 
vocal apparatus. To enable our ideas to be 
more readily understood, let us observe in the 
first place, what takes place when the larynx is 
carried to the highest possible point, and the glottis 
has just given out the highest note of which it is 

♦ This word should be written faucette; for I cannot admit the 
etymology of the lexicographers, who write falsette, as if derived 
from false, the opposite to true, and therefore prefer, as more ration- 
al, and more conformable tj my ideas, the etymology of the Latin 
faucium, the throat, the gullet. The orthography should, 
therefore, be changed. I have also, in support of my opinion, that 
of J. J. Rosseau, who, like myself, attaches no idea of false to the 
acute sounds of the voice. 

5* 



54 THE VOICE. 

capable. Then elevated by the contractions of 
the thyro-hyoid, genio-hyoid, mylo-hyoid, stylo- 
hyoid, the digastric, the genio-glossal and hyo- 
glossal muscles, and, finally, by the inferior 
constrictors of the pharynx, the vocal instrument 
is fixed and restrained by the action of the hyo- 
thyroid, lateral, hyo -arytenoid, oblique and trans- 
verse, and the inferior and superior thyro-aryte- 
noid muscles ; at the same time, the pharynx is 
contracted and compressed, the veil of the palate 
is strongly stretched and raised so as completely 
to stop up the posterior orifices of the nasal 
sinuses ; the uvula is shortened even to its 
obliteration in the highest notes, the tongue is 
contracted and elevated to its base by the con- 
traction of the glosso-palati muscle, the columns 
are approximated and strongly marked ; the 
tonsils are swollen and form a considerable pro- 
jection ; the opening of the windpipe is con- 
tracted ; finally, the vocal sound no longer issues 
in part through the nose,* but rings in the mouth 

* This is the reason why women in general, tenors and soprani, 
are less easily understood in the singing of words than the baritones 
and base. It is almost impossible for acute voices to pronounce 
distinctly the nasal sounds, especially in the high notes of the fau- 
cette. This peculiarity will be readily understood by reflecting, that 
for the articulation of the nasal syllables, the air must issue through 
the nose ; but, as in the faucette, the veil of the palate opposes this 
passage of the air, the syllable in must necessarily take the sound 
of a, exactly as the 'sound a must, in its turn, take that of in, when 
the effort is made to pronounce it with the mouth closed. 



THE FAUCETTE VOICE. 55 

after having been produced by the air, which 
breaks in a delicate stream against a new glottis 
formed by the veil of the palate,* the base of the 
tongue, and all the contracted and approximated 
organs we have mentioned. The form of the 
vocal tunnel, in particular, appears to undergo 
the greatest change ; really, in the laryngean 
voice the tunnel has two external orifices, the 
nose and the mouth ; it is curved backward 
superiorly. On the other hand, in the faacette, 
it has but one orifice and a vertical and straight 
direction, favored by the elevation of the larynx, 
and the head bent backward, which facilitates the 
contraction of the organs and prevents the sound 
from issuing by the sinuses of the nasal cavities. 
Finally, in the voice of the first register the 
bucco-pharyngean cavity forms two hollow cones, 
the bases of which turned towards the glottis are 
confounded together, and the two distinct sum- 
mits of which are anterior ; on the contrary, in 

* May it not be admitted, that all parts of the pharynx which 
contribute to form this new glottis, are capable of producing vibra- 
tions, as the vocal cords? This is my opinion ; and I think these 
vibrations may be compared to the labial vibrations produced by the 
lips, when, by forming with them a kind of sphincter, and an open- 
ing to give passage to the air which breaks against their borders, it 
is desired to imitate certain noises and sounds, such as the noise of 
a turning wheel, that produced by the wings of a large fly or bum- 
ble-bee — finally, the sound of a horn or bassoon, or the scraping of 
a bow upon a violin, etc. 



56 THE VOICE. 

the voice of the second register, the mouth and 
pharynx form but one cone, with the summit pos- 
teriorly and base anteriorly. 

During the mechanism of the faucelte, the 
larnyx, or rather the glottis, no longer vibrates in 
an evident manner, its purpose then is to contract 
considerably the orifice from which escapes the 
delicate stream of air, which, with that already 
found in the larynx, is sufficient for the sounds of 
the faucette. For the more satisfactory explana- 
tion of this idea, and especially to prove that it is 
sometimes possible to speak without the assistance 
of the larynx, I will relate some facts ; among 
others the following, furnished me by Dr. Delean, 
and which I have since repeated. This ingenious 
physician, to whom science owes several important 
works upon the diseases of the ear, addressed a 
letter, in 1829, to the Academy of Sciences, in 
which he said : " Introduce through one nostril 
into the pharynx a hollow tube, which will permit 
the passage of a current of air contained in a 
vessel of moderate capacity ; as soon as you feel 
the current of air strike upon the posterior walls, 
suspend the action of respiration and put in mo- 
tion the organs of speech, as if you were acting 
upon the air of the lungs ; you will speak in a low 
voice, you will cause distinctly to be heard all 



THE FAUCETTE VOICE. 57 

the elements of aphonic speech. Fearing to be 
deceived with regard to the power of interrupting 
the action of the chest, while I put in play the 
organs of speech, I attempted to speak in a loud 
voice ; the current of air established by the nose 
was in all its force ; at the instant two words could 
be heard in a manner so distinct and pure, that 
those who assisted in the experiment thought they 
heard two individuals repeating the same phrases. 
This experiment therefore satisfactorily proves, 
that the larynx is of no utility in aphonic speech." 
Struck with an experiment so conclusive, I 
tried upon myself, whether I could not produce, 
at the same time, two vocal sounds of different 
mechanism ; that is to say, a note of the larynx, 
and one of the faucette. I accomplished this 
result very readily, by taking at once a grave 
note by a strong vibration of the glottis, and its 
octave with the faucette. Two notes can thus be 
distinctly heard ; although they have not a very 
clear sound, and are somewhat hoarse, they form 
a kind of harmony which, in connection with the 
experiment of M. Delean, proves that the larynx 
is not always the generating organ of the voice ; 
and that the veil of the palate, the uvula, and the 
organs of the isthmus of the windpipe, form, by 
their forced contraction, another kind of vocal 



58 THE VOICE. 

instrument, which does not depend upon the lar- 
ynx, except in so far as the air is furnished by 
the latter. 

I expect this theory will meet with many at- 
tacks, but as it has some analogy with that of 
Professor Gercly, of Malgaigne, and Bennati, the 
attacks upon myself will appear less vivid, and I 
shall feel stronger in reply, since I do not stand 
alone. 

Moreover, the w r ord faucette, which is derived, 
as I have already said, according to J J. Rous- 
seau, from the Latin fauces, the throat, and not 
from falsus, false — seems to indicate that the 
ancients had some idea of the formation of acute 
sounds, and that they considered them to be pro- 
duced by a peculiar mechanism of the superior 
parts of the vocal tunnel. Ferrein, after having 
placed the organ of the voice in the vocal cords, 
considered as cords, adds : " I find myself obliged 
to make a restriction wholly unexpected, that the 
vocal cords are not the organs of all kinds of the 
voice ; such are a certain voice of the windpipe 
and a falsette of the same nature." " These 
require a new organ which I have discovered, 
and the existence of which I have taken care 
to establish ; these facts will be explained in 
another article." Although Ferrein lived a long 



THE FAUCETTE VOICE. 59 

time after his pretended discovery, he never pub- 
lished any thing respecting this article, which he 
promised, and we are reduced to conjectures with 
regard to its contents. Haller supposed that he 
referred to the veil of the palate : Quin aliquse 
non litterse solse, sed etiam voces per guttur edan- 
tur, et quin earum modulatio aliqua per palatum 
mobile aut proprias ad linguam adductum, aut 
vicissim remotius exerceatur. Dubium quidem 
non videtur esse illud peculiare vocis organum 
quod se descripturum promisit Ferrinius, etc. 

A German author also says some words upon 
the faucette voice, which he calls vox substricta, 
and the chest voice, vox plena. This author, 
Helwag, of Tubingen, says only : Ad substrictam 
vocem uvula contrahitur, ad plenam non mutaiur. 

From what has been said it will be seen, 
that we are not the first who have spoken of a 
mechanism, other than that depending upon the 
muscles of the larynx, for the formation of the 
faucette voice ; but as we do not share the opin- 
ions of other physiologists in this respect, we will 
point out in what they differ from our own. 

Firstly, so far as concerns Ferrein and Dr. 
Helwag, we do not think it necessary to say any 
more, for they have but glanced at a different 



60 THE VOICE. 

vocal mechanism for the acute notes, without 
giving any more than we have cited. 

The theory of Bennati differs from our own in 
several respects. In the first place, this physi- 
cian says that the acute sounds are not produced 
by the contractions of the muscles of the veil of 
the palate and of the isthmus of the windpipe, but 
that he, with all the physicians and physiologists 
who have been engaged upon the voice, admits, 
that the formation of the supra-laryngean sounds 
is effected like all the others in the larynx, but that 
they are merely modified by the superior part of 
the vocal tunnel. We assert, on the contrary, that 
the glottis is of no utility in their formation, and 
that they are produced by another species of su- 
perior glottis, formed by the elevation of the lar- 
ynx, and the contraction of the muscles of the 
pharynx, veil of the palate, base of the tongue, 
etc. ; that is to say, by the contraction of the in- 
ternal and external peristaphyline, the palato- 
staphylins, glosso-staphylins, pharyngo-staphyl- 
ins, stylo-glossal, stylo-pharyngean, mylo-hyoid, 
genio-hyoid ; finally, of the palato-pharyngean, 
and glosso-pharyngean. M. Bennati assigns to 
the larynx an important part in the sounds which 
he calls supra-laryngean, while we look upon it 
merely as a continuation of the trachea, and serving 



THE FAUCETTE VOICE. 61 

only as a Moio-pipe, and a point of support which 
contributes, by its closure and the contraction of 
its muscles, to form in the isthmus of the windpipe 
the new superior glottis we have first mentioned. 

The organs, whose simultaneous approximation 
forms the new glottis, which generates acute 
sounds, are, 1st, inferiorly the summit of the lar- 
ynx and the base of the tongue — to which, in my 
opinion, M. Bennati assigns functions of too much 
importance in singing ; 2d, the pharynx, or pos- 
terior wall ; 3d, the columns and tonsils at the 
sides ; 4th, the veil of the palate and the uvula ; 
which, by their elevation, prevent the air from 
issuing by the nasal fossae, as in the chest voice.* 
When all these parts are approximated by the 
contraction of the muscles, the bucco-pharyngean 
cavity forms a cone, the base of which corre- 
sponds to the opening of the mouth. 

Neither do I share in the opinion of M. Bennati, 
when he says that the hyoid bone and the base of 
the tongue must be fixed for the formation of the 
acute or supra-laryngean sounds ; this fixing 

* When in the chest voice, and during the articulation of words, 
the air does not issue from the nasal sinuses, the voice is harsh and 
nasal ; in the faucette, on the contrary, the air should only issue 
by the mouth. Thus those who have a nasal and disagreeable 
voice in the middle sounds and the base notes, may produce sweet 
and harmonious sounds by taking the faucette. 

6 



62 THE VOICE. 

might be imagined necessary for the production 
of the sounds in modulated singing ; but in spoken 
singing, this theory is inadmissible, for the base 
of the tongue, as well as the entire organ, is 
obliged to make a great number of movements 
for the articulation of the words. 

Gerdy and Malgaigne have simply described 
with great accuracy the movements of the veil of 
the palate, and of the organs of the superior part 
of the vocal tube, but they have not said that 
these movements had for their object the forma- 
tion of the notes composing the second register, 
and that their approximation gave origin to an- 
other instrument, the only generator of the acute 
sounds, without the participation of the true glot- 
tis. The former is not formed until the latter has 
exhausted all its notes, and produced its highest 
diapason. 

By simple inspection of the vocal organs, it is 
easy to recognise the kind of voice of each indi- 
vidual ; the differences of conformation and espe- 
cially of capacity of these organs are so sensible, 
that it is almost impossible to be deceived in this 
respect. 

Singers with an extensive voice, especially in 
the high notes, such as soprani and tenors, have 
the upper portions of the vocal apparatus much 



THE FAUCETTE VOICE. 63 

more developed and more movable than the 
base. In the latter, the larynx is larger and de- 
scends to the very middle of the neck ; the ante- 
rior projection of the thyroid cartilage (Adam's 
apple) is more distinct ; the nose is longer ; the 
nasal sinuses are more extensive, perhaps because 
the air is constantly traversing them,* the shoul- 
ders and chest are larger ; but the mouth on the 
contrary is smaller, the veil of the palate thicker 
and not so large, the uvula less projecting and 
movable ; finally, all the parts constituting the 
isthmus, properly so called, are in general more 
contracted. In tenors and soprani, the figure is 
smaller, although the posterior fauces are larger ; 
the larynx ascends under the lower jaw, the nos- 
trils are sometimes so narrow, that they scarcely 
permit the passage of the air, but the uvula is 
developed and very contractile, the veil of the 
palate larger and thinner, and the tongue is pro- 
portionately thicker and larger. The reason why 
these organs are more developed in the soprani 
is, perhaps, that singers of this species of voice 
exercise more frequently the superior part of the 

* In the voice of soprani, the air does not issue through the nasal 
fossae except in some notes of their first register ; in base voices, on 
the contrary, it always issues in a great measure by the nose, for 
those persons who have a very grave voice can scarcely ever take 
the faucette. 



64 THEVOICE. 

vocal tube ; thus these portions are never more 
fatigued than after the parts which are written to 
be sung in the high notes of the second register, 
which require the faucette. This fatigue, ex- 
perienced by soprani singers, rarely extends be- 
yond the limits of the summit of the vocal tunnel, 
and if increased by too long an exercise it might 
occasion a pharyngitis ; but this inflammation, 
w r hich sometimes extends to the larynx and even 
to the trachea, would never reach the bronchi or 
the lungs. On the contrary, in base and other 
singers whose voice is almost always in the first 
register, the fatigue is principally felt in the 
larynx and the organs of the inferior part of the 
vocal apparatus, such as the lungs, pleurse, and 
all the pectoral and diaphragmatic regions ; in 
consequence of which, inflammations of the tra- 
chea and bronchi and peripneumony are not rare 
in those who sing almost exclusively parts written 
in the first register ; although the fatigue is less 
speedy in singing in the grave tones than in the 
acute. 

The diseases of the vocal and respiratory or- 
gans are not the only complaints, to which singers 
are liable ; and we will now point out various 
accidents peculiar to each class, and which are so 
entirely distinct as to require particular attention. 



THE FAUCETTE VOICE. 65 

The voices of the first register, especially the 
base, relax the muscles of the abdomen and peri- 
toneum ; whence the disposition to hernia and 
ventral obesity contracted by singers of this class. 
Ramazzini, Fallojrius, and Mercurialis ascribe 
to this cause above every other the great number 
of abdominal hernias, which were met with among 
the monks, who sang with grave voices for the 
greater part of the day in the churches. Acute 
voices send the blood towards the superior parts, 
and predispose to cerebral congestions. In fact, 
if you examine a person who is giving a sound in 
faacette, you will observe the face to be red and 
tumid, and the muscles of the countenance to be 
strongly contracted ; that the vessels of the neck 
and forehead are swollen and very apparent ; 
finally, that the eyes are injected, fixed, and 
brilliant. Female singers, tenors and soprani 
are very liable from the exertion of singing in the 
high notes to vertigos, headaches, bleeding at the 
nose, ringing in the ears, strong pulsations of the 
temporal arteries, and even to various nervous 
affections, which Ramazzini claims to have ob- 
served. 

The exercise of singing when too long con- 
tinued, fatigues much more than that of speaking, 

although the latter requires the concurrence of a 
6* 



66 THE VOICE. 

much greater number of organs. Singing actu- 
ally demands the most ready and best sustained 
action of the larynx, which is, on the one hand, 
soon dried by the rapid and continual current of 
air which traverses it ; while, on the other hand, 
the lungs largely dilated by this fluid retain it for 
a longer or shorter time, contrary to their natural 
function and the mechanism of respiration. As 
the air intended for the instrument forming the 
voice must be driven out from the lungs without 
interruption, its issue is always very slow and 
greatly prolonged ; and it is, in my opinion, one 
of the most important and difficult things for a 
singer to know how to renew, without interrupting 
the sound, his supply of air, by making an inspi- 
ration at the very moment when the measure 
marks the natural repose of the musical phrase. 

The result of these different phenomena which 
we have noticed in singing is, that the glottis and 
the entire larynx are fatigued by the frequent and 
prolonged contractions and vibrations of the mus- 
cles, which put them in motion ; the mouth and 
throat are dried and irritated ; the act of respira- 
tion, modified in its mode of action, soon wearies 
the inspiratory organs, and the delay in the sup- 
ply of new air to the lungs, causes the oxygena- 
tion of the blood to languish, as well as the 



THE FAUCETTE VOICE. 67 

chemical action of this function. The circula- 
tion, so closely united to the movements of the 
organs of respiration, is soon embarrassed ; the 
blood stagnates in the pulmonary artery ; the 
whole venous system discharges its function bad- 
ly ; the jugulars are swollen, and the cerebral 
veins, soon gorged by the blood, are distended by 
this fluid. This disorder of the respiration and 
pulmonary circulation often causes its bad influ- 
ence to be felt in the abdominal viscera, the natu- 
ral motions of which are delayed, because they 
remain during the entire inspiration in a state of 
uneasiness and compression, which is particularly 
painful to the stomach, especially after eating, 
when this organ is distended by food. 

All these disorders of the circulatory and res- 
piratory functions, that we have pointed out, do 
not become very manifest, until the singing is 
prolonged beyond measure, or when the singer 
makes great efforts, especially in a different regis- 
ter from that which is natural to his voice. Then 
hoarseness and even complete aphony takes place, 
and the vocal sounds lose all their brilliancy, 
sweetness and harmony. A sense of heat is at 
the same time experienced in the chest, and a 
kind of dryness and fatigue in the throat ; the 
respiration is rendered more active, the arterial 



68 THE VOICE. 

pulsations are more frequent, and there exists in 
the throat a sort of constriction, which is rendered 
more painful by the constant thirst. Often, too, 
the cutaneous perspiration is augmented, and the 
whole capillary system of the skin, more particu- 
larly that of the face, is injected with blood ; 
lastly, this state of fatigue and this disorder of the 
functions might even be attended with more seri- 
ous consequences, if prolonged repose and well- 
directed care did not soon reestablish the har- 
mony and the health of the system. 

Most of the serious results spoken of are con- 
siderably diminished by the happy effect of fre- 
quent singing ; they are even in a great measure 
redeemed by several advantages to be found in 
the practice. The first of these advantages is 
the better development of the chest, and the 
strengthening of the vocal and respiratory organs, 
at the same time that our animal economy expe- 
riences the happy effects of an exercise filled 
with charms, and which exerts its sweet influence 
over our feelings and ideas. 

The most natural object of singing is to ex- 
press pleasure and joy ; and with truth has Gretry 
said, that singing is to man the sign of his perfect 
happiness and liberty ; wherever he may be 5 the 



THE FAUCETTE VOICE. 69 

happy man sings, and thus manifests the lively 
sentiment of the happiness he experiences. 

The charm which always accompanies singing 
will suffice to indicate how many advantages 
those who give themselves up to it with discretion 
and moderation may derive from it. The first 
of these advantages, which consists in a salutary 
movement impressed upon the whole body, must, 
I think, be referred to gymnastics and hygiene ; 
disguised as an exercise, singing may be useful 
in a multitude of circumstances, and, above all, 
eminently capable of strengthening the thoracic 
and vocal organs. In union with music, it often 
produces great effects upon the nervous system, 
and may be made the means of cure in many 
nervous diseases. Oribazius, in his collections, 
gives some useful and interesting details upon the 
good effects of singing in preventing, curing, or 
alleviating a great number of diseases, as those 
of the lungs, bad digestion, the depraved tastes of 
females enceinte or chlorotic. Plutarch con- 
siders that the exercise of the voice may con- 
tribute to the health of the body. Celsus boasts 
its utility in weakness of the stomach ; Celius 
Aurelianus against pains in the head, mania, and 
catarrh. 

The moderate exercise of singing may also be 



70 THE VOICE. 

advantageous in those affections with which the 
imagination is much occupied, such as dyspepsia, 
and gastro-enteralgia ; by serving as a means of 
distraction, and dissipating the idea of the disease, 
it will be made to disappear in part. A great 
many facts prove that singing joined to music is 
also very favorable in certain epidemics, espe- 
cially as a protective measure, and the observa- 
tion we have just made during the epidemic of 
the cholera, proves to us that those who were 
occupied with singing and music have but rarely 
been attacked by this terrible scourge.* Hip- 
pocrates and other physicians of antiquity have 
also recommended the practice of singing ; but, 
like modern authors, they could not agree upon 
the cases requiring it. We consider, however, 
that the moderate exercise of singing, speaking, 
and of declamation, may be proper for persons of 

* In epidemics and other scourges of this kind, such as the cholera 
and the plague, which desolate an entire country, many persons 
fall victims to terror rather than disease. Reason and observation 
equally prove how useful singing would be to them, since it has 
always the property of dissipating their terror. It often happens 
that the mind, constantly occupied by the fear of the disease, calls 
for it, so to speak, and gives it birth. Diemcrbroek, in his Treatise 
upon the Plague, pp. 286, 232, 252, cites several cases of the plague 
cured by singing and music. Pig-ray, who says that sadness and 
fear are the nourishment of the plague, also cites several observa- 
tions of the same kind. Desault, too, declares that singing is ad- 
vantageous in the treatment of insanity and consumption. 



THE FAUCETTE VOICE. 71 

little activity, who have naturally a veiled and 
hoarse voice, and whose lungs, well formed in 
other respects, lack tone and energy, and are 
therefore more exposed to a species of cold or 
mucous embarrassment. 

Singing was much esteemed by the ancients, 
and the Greeks, in particular, employed it to in- 
culcate morality. Bartholemy relates that the 
youth, accustomed at an early age to sing, found 
in this exercise the love of good and the idea of 
true virtue. Their songs, by turns patriotic and 
warlike, melancholy and voluptuous, attached 
them to their country, carried them to battle, and 
disposed them for the sweets of peace and the 
pleasures of love. 

Although singing is less esteemed among us, it 
always gives pleasure to all men, and we find it 
practised with equal delight by the shepherd and 
the soldier, the mechanic and the noble. It 
forms, when united to music, the chief ornament 
of our large assemblies and our theatres, and it 
furnishes in our churches the truest and most 
touching accents, which can be inspired by piety, 
grief, gratitude, or adoration. Who has not felt 
his soul elevated to God by holy hymns ? and 
whose eyes have not filled with tears, whose 
heart has not been touched by hearing funeral 
and religious songs ? 



72 THE VOICE. 

Before terminating my remarks upon the voice, 
I will add some words upon its metamorphosis at 
the age of puberty. At this period a great revo- 
lution takes place in man, and the vocal timbre 
is completely changed ; for the voice, in boys 
especially, usually loses an octave. At this criti- 
cal period very great precautions must be taken, 
that the exertion of singing does not occasion a 
weakness of the vocal organs, by which their 
development might be arrested. M. Bennati has 
given, in his treatise upon the voice, some ex- 
cellent precepts with regard to the precautions to 
be taken at the season of puberty. As we have 
nothing to add to what has been said by this 
physician upon this subject, we shall here make 
an extract from his work. " Devoted at a very 
tender age, by pleasure and taste, to the study of 
singing, I possessed a very well-marked soprano 
voice. At the period of change, which occurred 
to me at fourteen years of age, my master ceased 
his lessons for several months ; after this interval, 
he remarked that my voice had lowered precisely 
an octave ; but perceiving that I still touched, al- 
though imperfectly, some of the higher notes, 
(which he called falsetto notes,) he encouraged 
me to practise them gradually and without effort, 
by telling me that they would finally procure for 



THE FAUCETTE VOICE. 73 

me a second register, which, although distinct, 
would be in unison with the first, and would 
greatly increase my resources. To this moderate 
study I owe the development of the organ, which 
now can mark three octaves." 

" These observations will not be without use 
in the direction of singing-masters, as well as the 
parents of children having a predisposition to the 
development of the organ of the voice. After 
having first prepared the hearing of the latter 
with a taste for music, which they should study 
mechanically till about the age of seven years, it 
will be best, as soon as they have been taught 
to open the mouth, and give it the most favorable 
form for the projection of sound, to make them 
execute gradually, and in very slow movement, 
not entire gamuts, as is usually done, but merely 
the notes they can sound without effort. Great 
care must be taken not to prolong this exercise 
more than a quarter, or at most half an hour each 
day, according to the constitution of the subjects, 
for fear of doing injury to the organ of the wind — 
that is to the lungs and their dependents — which 
would readily occasion results similar to those I 
have already pointed out, as the consequence of 
the exercise of singing during the change of 
puberty. 

7 



74 THE VOICE. 

" By following the course I have indicated, the 
teacher disposes to contract spontaneously, under 
the influence of the will, the muscles, which, 
after they have reached their entire development, 
will possess both flexibility and power. 

" This suppleness and play are precisely what 
is wanting to those persons, who commence the 
study of singing at a late period of life ; the 
muscles having till then remained in vocal and 
modulating inactivity, oppose more resistance and 
rigidity to the will, because they have become 
fully developed. Perhaps these remarks ought 
to be taken into consideration by the directors 
and masters of musical societies, to whom I doubt 
not that the more perfect knowledge of the vocal 
apparatus, joined to the history of the former 
musical education of the pupils, would be of very 
great utility, in enabling them to discern those 
subjects which have a real aptness for singing. I 
dare almost affirm, that the meagre quality of the 
voice, which is reasonably complained of from 
fifteen to twenty years of age, has for its first 
cause the irrational direction which is given to the 
organ of children, among whom the happiest 
organic arrangements are often made of no avail 
by exercises, not only premature and beyond the 
vocal strength of the individual, but even at peri* 



THE FAUCETTE VOICE. 75 

ods contrary to vocalization, which has a special 
modulating power entirely distinct from that which 
belongs to an inorganic instrument." 

Our opinion, as may be imagined, is the same 
with that of M. Bennati, — that it is of the highest 
importance to permit the young pupils to sing 
only those pieces of music, which are entirely 
within the scope of the voice, and which do not 
expose them, in consequence of too great and 
prolonged efforts, to lose the happy dispositions 
they may have for singing. If certain musical 
compositions have changed the voice, and even 
taken away all their powers from persons, whose 
voices were already formed, with how much 
stronger reason would music of the same kind 
prevent the development of the vocal organs in 
young, feeble and delicate subjects. 

As the study and habitual exercise of singing 
are followed by real dangers, I think best to point 
out in this place what conditions are necessary to 
render singing always compatible with the preser- 
vation of the health ; it is not sufficient that a 
singer has a pure and sonorous voice, a delicate 
ear, a just intonation; in addition to these ad- 
vantages he must possess a well-formed chest, 
healthy and ample lungs, easily contracting and 



76 THE VOICE. 

expanding ; his neck should be well proportioned, 
that is, neither too short nor too long. 

Even when all these conditions are united, he 
must, as we have already said, always keep with- 
in the scope and character of his voice, and be 
careful to sing with moderation, never exceeding 
his powers. If a singer, who practises his art 
much, would preserve his organ for a long time, 
he must carefully avoid every error in regimen, 
and lead a most regular life. Singing, to be easy 
and pure, requires that the stomach should con- 
tain but a small quantity of food, and that the 
abdomen, chest and neck should experience no 
uneasiness or compression. If most of these 
conditions are not present, the exercise of singing 
may be attended with grievous results; and it 
would be well to forbid it to those persons, who 
are far from having the happy conformation of the 
organs which singers should have. Delicate and 
nervous persons, w T hose chest is narrow and irri- 
table ; young persons scarcely developed ; those 
who are predisposed to cough, and easily take 
cold ; finally, invalids, especially those with pul- 
monary tubercles, sooner or later find in the pro- 
longed exercise of singing the cause of a disease, 
to which they very often succumb. In fact, nearly 
all these victims of the voice become haemoptisi- 



THE FAUCETTE VOICE. 77 

cal, or are attacked with pulmonary or laryngeal 
phthisis. These counsels, which all those who 
are destined for the stage, and all professors of 
singing, should never lose sight of, may be of the 
greatest utility, and will certainly contribute to 
increase the number of singers with extensive 
and flexible voices, who often lose all their pow- 
ers by the irrational direction which is followed 
in their musical and vocal education. 

It has already been shown, that the play of 
each part of the vocal organ depends upon the 
will, and that we can at pleasure vary the force, 
tone, and timbre of our voices, so as to produce 
the most extraordinary and varied illusions. For 
instance, by putting in action in a certain and par- 
ticular manner, this or that part of the speaking 
apparatus, we succeed in perfectly imitating the 
cries of animals, the voices o£ other men, and 
even the most confused noises. As we cannot 
here enter into long, details upon this subject, we 
will content ourselves with a few words upon that 
illusion of the voice, which is called ventriloquy ^ 
or engastrimysm. 

Engastrimysm — from the Greek sv 9 in ; 
y«$Ti79, the belly ; fivd-og, speech; meaning speech 

from the belly — is a kind of hoarse voice, some- 

7# 



78 THE VOICE. 

times distant, sometimes near at hand, which 
produces the most varied vocal illusions. 

The ventriloquists were formerly regarded as 
possessed of the devil, because ignorant and su- 
perstitious men have always attributed to super- 
natural causes every thing which exceeded their 
comprehension ; but now that the progress of sci- 
ence has in part dissipated the darkness of super- 
stition, and illumined the horizon of the human 
mind, our ideas with regard to ventriloquism have 
become more exact, and it is generally agreed 
that this art may be learned like any other, and 
that its effects, in appearance magical, are due to 
a peculiar order of action of the vocal organs. 

But, I shall be asked, What is the mechanism 
which produces this peculiar illusion of the voice ? 
Before expressing my own opinion upon a subject 
so little studied and known, I will briefly allude to 
those of physiologists and ventriloquists, which 
very often contradict each other. It was for- 
merly always supposed, and nearly every body 
still believes, that the voice of ventriloquists was 
produced in the belly ; and from this idea the 
name of ventriloquy was unfortunately created. 
Rolandi said, that when the two pleurae, usually 
united by the fold of the mediastinum, remained 



THE FAUCETTE VOICE. 79 

separated, the voice seemed to come from the 
pectoral cavity, and the individuals were ventrilo- 
quists, 

Amman, Nollet, and Holler, said that the voice 
of ventriloquists was formed during inspiration. 

In 1770, Baron Mengen, an Austrian colonel, 
who was a ventriloquist, gave the following ex- 
planation, the truth of which he had verified, he 
said, upon himself; the tongue was pressed 
against the teeth, and the left cheek circumscribed 
about it a cavity, in which the voice was produced 
by the air held in reserve in the throat. The 
sounds then had a hollow and hoarse timbre, 
which gave rise to the opinion that they came 
from a distance. It was necessary, according to 
him, to husband the air, and respire as seldom as 
possible. 

Dumas and Lauth said, that ventriloquy was a 
rumination of the sounds, which, after being 
formed in the larynx, were driven back into the 
chest, where they received a peculiar timbre, and 
made their way out with a hoarse and distant 
character, which was the cause of the illusion. 

Richer and, and Fournier are of opinion, that 
the voice, formed in the glottis, is afterwards 
crowded back into the lungs, whence it only issues 
in a gradual manner, to be then stopped by the 



80 THE VOICE. 

larynx, which acts like the sounding-board of a 
musical instrument. 

Comte, our celebrated ventriloquist, says that 
the voice is formed, as usual, by the larynx, but 
that the play of the other parts of the apparatus 
modifies it, and that inspiration directs it into the 
thorax, where it resounds. 

Finally, Dr. Lespagnol has maintained in a 
thesis, that it is principally by the veil of the pal- 
ate that the sounds can be so modified as to grad- 
uate the intensity of the voice, and produce the 
illusion of ventriloquism. This latter theory very 
nearly approaches my own, for it differs from it 
only in that its author merely speaks of the action 
of the veil of the palate, and says that it is only 
this action, which produces ventriloquism by pre- 
venting the air from issuing through the nasal 
fossae. The whole difference, says M. Lespagnol, 
which exists between the near and the distant 
voice is, that in the former are heard the sounds 
which issue from the mouth and nose, while in 
the latter they issue only from the cavity of the 
mouth. The remark of this physician, with re- 
gard to the issue of the air, may be verified by 
any one, especially if he will employ the vocal 
mechanism about to be indicated as being, in my 
opinion, that which produces ventriloquism. Thus 



THE FAUCETTE VOICE. 81 

we see that to speak like ventriloquists, or rather 
to speak from the abdomen, as it is improperly 
called by people in general, will not require a 
peculiar conformation of the organs of respira- 
tion and of the voice ; it is sufficient merely to be 
possessed of a certain elasticity of the upper part 
of the speaking apparatus, and, with a little skill 
and practice, it will be very easy to produce all 
the vocal illusions constituting the art of the ven- 
triloquist. 

As, on the one hand, men have in general a 
secret and involuntary inclination, which leads 
them to imitate all the actions witnessed by them, 
and since, on the other hand, it has been observed 
that of all our organs none is better adapted for 
imitation than that of the voice, it will not, in my 
opinion, be advancing too much, to assert that a 
person, especially if young, who should live in 
the company of a ventriloquist, would soon almost 
involuntarily become so himself; exactly as two 
individuals, who live a long time together, finally 
have the tone of their voices in harmony, and 
what is still more admirable, their voices acquire 
nearly the same timbre. 

Convinced that to be a ventriloquist it was suf- 
ficient to have well -formed and very movable 
vocal organs, as well as lungs very ample and 



82 THE VOICE. 

permeable to the air ; and as, moreover, I though^ 
all these conditions my own, I succeeded by 
making experiments upon my own voice in closely 
imitating that of the ventriloquists. A certain 
degree of skill, and the faculty so predominant 
among them of imitating all the vocal inflexions, 
were only wanting to produce all the illusions of 
their art. 

When it is my intention to speak with the voice 
of ventriloquists, I employ the following mechan- 
ism : at first, after having made a deep inspira- 
tion, the object of which is to introduce into the 
chest the greatest possible quantity of air, I 
strongly contract the veil of the palate, in order 
to elevate it so as completely to stop the posterior 
orifice of the nasal fossae. At the same time, I 
take equal care to contract the base of the tongue, 
the pharynx, the larynx, the columns, the tonsils, 
while I fix the point of the tongue behind the 
teeth of the upper jaw, and apply the dorsal face 
of this organ against the palatine vault. I cause 
the emission of my voice to be made with the 
expulsion of the least possible quantity of air from 
the lungs, and I easily obtain this result by forced 
contractions of all the muscles of the abdomen, 
chest and neck. 

The principal secret of the ventriloquists then 



THE FAUCETTE VOICE. 83 

seems to be, to prevent the air from issuing by the 
nose, and to compel this fluid to escape by the 
mouth in a slow and forced manner. The voice 
is thus rendered hoarse, and seems to have the 
weakness and timbre, as if it were from a dis- 
tance. To increase the deception, by giving to 
the voice a sound which seems to come from a 
determinate spot, it is sufficient adroitly to direct 
the attention to this spot, and afterwards to speak 
in that direction by elevating in a greater or less 
degree the veil of the palate, so as to render the 
voice distant, or near, as the wish may be. The 
effort must also be made to speak with the least 
possible movement of the lower jaw, and to be 
careful to articulate in some sort with the mouth 
closed ; finally, the ventriloquist should present 
his profile as often as he can, that his countenance 
may appear more at rest, and as destitute of ex- 
pression as a blind man's ; he will thus appear to 
take no part in the vocal sounds which are heard, 
and will easily succeed in producing a more com- 
plete illusion. 

To finish what I have to say upon all the 
phenomena of the voice, I will add some words 
upon that expressive vocal sound, constituting 
what is called the cry. 

The cry is a kind of inarticulate voice, com- 



84 THE VOICE, 

mon to men and animals ; the double sound re- 
sulting from it is with difficulty appreciated, and 
its intonation, which varies infinitely, cannot, for 
this reason, be noted and calculated in a precise 
manner. I think, however, as will soon be 
shown, that although the variable diapason of the 
different cries can hardly be known, it is not 
impossible to express approximately, by ciphers 
or musical signs, the intervals of the double 
sounds forming the cries peculiar to every pain. 
In general, the tone of the cries is much more 
intense than that of the modulated voice, and it 
always presents something sharp, noisy, and 
capable of a thousand shades. Every animal has 
a cry peculiar to itself, and which presents a 
special character, only understood by the animals 
of its own species. Cries are eminently adapted 
to call succor, to fix the attention, and to make 
known, by the character of their intonation and 
distinctive accents, the different sentiments they 
are intended to express. The cries of pain, and 
those of terror caused by an imminent danger, 
for instance, excite, in a very different manner, 
those who hear them. The former inspire com- 
passion, the latter command us to act on the 
defensive, or induce us to fly ; the noisy cries of 
pleasure render us joyful, while the cries of 



THE FAUCETTE VOICE. 85 

despair wound our hearts and fill us with sadness. 
Every grief has its peculiar intonation. E very- 
pain has its peculiar intonation ; the cries of 
physical are different from those of moral pains, 
and these differ among themselves according to 
the expression to be given. The mechanism of 
the formation of cries does not differ essentially 
from that of other vocal phenomena. It may be 
referred to the formation of sounds of the first 
register, and more particularly to that of the 
second register, or faucette voice. As no one, 
that I know of, has ever written upon the mech- 
anism of cries, I will endeavor to make known 
the result of my own researches and observations. 
In my opinion, cries are produced by particular 
efforts, exaggerated and fatiguing contractions of 
the vocal organs. The voice is at first laryngeal, 
or of the first register, and terminates by a pro- 
longed and acute sound of the faucette, or second 
register. There are, therefore, two simultaneous 
mechanisms ; for we hear at first a very brief 
laryngeal sound, which may be represented by a 
base octave, and the second, which is more pro- 
longed, by its corresponding octave in the fau- 
cette. To understand our explanation of this 
double mechanism of the formation of cries, it 
8 



86 THE VOICE. 

will be necessary to call to mind our remarks 
upon the formation of the different vocal sounds. 
Pathologists and operating surgeons have not 
yet sufficiently studied the different intonations of 
pain ; they have only observed a difference in 
the cries, according to the kind of operation and 
the circumstances. It would, however, be useful 
always to have these different intonations present 
in the mind, for they would sometimes aid in 
forming a more just diagnosis in diseases, and 
would often protect physicians from making 
errors of judgment. For the more satisfactory 
explanation of the result of my observations upon 
the different cries, I will take for diapason or 
point of departure, do below the lines, warning 
my readers that this note, which I have selected 
as a standard, may vary with the individuals, but 
that the intervals resulting from the double sounds, 
which produce the cries, are almost always the 
same, and may be noted approximately. Thus 
I have observed, that cries caused by the applica- 
tions of fire are grave and deep, and that the 
double sound resulting from them may be repre- 
sented by the base octave and its third ; for ex- 
ample, the do I have just mentioned, and the mi on 
the first line. Cries which are drawn forth by 
the action of a cutting instrument during an ope- 



THE FAUCETTE VOICE. 87 

ration are acute and piercing, and may be ex- 
pressed, at first, by a rapid sound, or a double 
crotchet of the middle octave, which will be about 
sol on the second line ; and afterwards, and al- 
most at the same time, by a very acute and 
prolonged sound, or a semibreve of the octave of 
the faucette, which gives sol above the staff. The 
cries which result from pains occasioned by an 
acute affection, and not having for their cause an 
external action, are also represented by two 
sounds almost of equal duration, the octave and 
its sixth; the first corresponds to do taken as 
diapason, and the second to la within the staff; 
these cries are commonly called groans. The 
double sound resulting from the cry produced by 
a lively and sudden fright, or by an imminent 
danger, is the most discordant of all ; it may be 
expressed by the octave and the ninth, the do 
below the lines, and the re within the scale. 
Finally, the cries from the tearing pains of* labor 
are yet more acute and intense than all the 
others, and they have a peculiar expression well 
known and more remarkable ; the double sound 
resulting from them may be represented by the 
base octave and the seventeenth ; for example, 
the do and the re, upon the sharp of the second 
register. It seems that the atrocious pangs of 



88 THE VOICE. 

labor elevate the diapason of the voice, and at 
the same time augment its extent. I might also 
speak of the cries of joy and of sighs ; the former 
— formed equally by two sounds, one brief, the 
other prolonged — present an interval of one note 
only ; for instance, the re and mi. Sighs or tears 
are formed, at first, by three staccato notes, or 
three similar sounds produced during inspiration, 
and followed by a prolonged sound during ex- 
piration. The cry of sighing or of grief may be 
represented by three black notes and one white. 
Thus it is seen to be approximately possible to 
form a diatonic scale of the cries of pain.* It 
even appears that the spirit of invention, which 
torments mankind, and often causes them to 
imagine the strangest notions, has already led 
them to form with the cries of animals living 
organs, upon which they have succeeded in 
executing different airs.f 

* The* cries drawn from us by pain are a movement of nature, 
who seeks to relieve herself by producing a general expansion, and 
the fever which this occasions, concurs to generalize the evil for 
the purpose of diminishing its intensity ; it is thus that a color is 
weakened when combined with a liquid. 

f I cannot pass over in silence the following anecdote, related by 
Cahusac, and which is to be found in the dictionary of music of the 
" Encyclopedic Methodique," vol i. " John Christoval Calvette, who 
has given an account of the journey of Philip II. king of Spain, 
from Madrid to Brussels, tells this story : In a solemn procession, 
which was made in this capital of the Low Countries, in the year 






THE FAUCETTE VOICE. 89 

If the beauty of my subject has led me into 
physiological considerations, perhaps of too great 
length, the conclusions which I have drawn from 
them are of the highest importance, since they 
will often aid in making clear the diagnosis and 
therapeutics of those affections of the throat which 
influence the organ of the voice. 

Notwithstanding the numerous experiments of 
physicians and physiologists, and the precise in- 
formation furnished us by anatomy and physics, 
these sciences will never be but imperfect auxil- 
iaries, which will present no mathematical con- 
clusions with regard to the different phenomena 
of the voice, because the power of life occasions 
in the production of the vocal sounds various 
modifications, the immediate cause of which will, 

1549, during Ascension week, immediately after the archangel St. 
Michael, covered with glittering armor, hearing in one hand a 
sword, and in the other a balance, came a car, on which was seen a 
man disguised as a bear, who played upon the organ. It was not 
composed of pipes, like all other organs, hut of cats enclosed sepa- 
rately in narrow boxes, so that they could not turn, their tails stick- 
ing out above. They were tied by cords to the stop, so that when 
the bear pressed upon the keys, he pulled the tails of the cats, and 
made them mew tenors, high and low, according to the airs he 
wished to execute. The arrangement was so made, that there was 
not a false tone in the execution. Monkeys, wolves, stags, etc., 
danced upon a stage carried on a car, to the sound of this singular 
organ." This history, translated by Cahusac, goes to prove that the 
cries of animals are a true singing, formed by various tones, and of 
appreciable intervals. 

8* 



90 THE VOICE. 

perhaps, always remain covered with an impene- 
trable veil, which the most skilful investigators 
will be able but imperfectly to raise. 

In conclusion, who can ever explain in a satis- 
factory manner, why the will renders the air 
sonorous at the moment when it traverses the 
glottis, and why, when the empire of this power 
ceases, the passage of this fluid is effected without 
noise ? We must put up with our ignorance on 
this subject, and say, with the Latin poet, 

" Felix qui potuit rerum cognoscere causas." 

Such is the history of the voice, with the physi- 
ological aspect of which we have been occupied, 
before entering upon the pathology and therapeu- 
tics of the organs which produce it. 



CHAPTER V. 



APHONY AND DYSFHONY. 



" Non omnia omnibus prosunt auxilia." 

Morgagni. 



Aphonia, of the Latin — from a privative, and 
(purr), the voice, of the Greek — is an incapacity 
of producing the vocal sounds, which is always 
accompanied with a privation of sonorous speech. 

Dysphonia — from the Greek &v g, with diffi- 
culty, and cpwv/), the voice — is an alteration of the 
voice, which renders its emission more or less 
difficult, and often even painful. 

These affections must not be confounded with 
mussitation and dumbness ; in the latter, the 
emission of the simple voice is uninjured, but not 
being modified by the motion of the tongue, lips, 
and other parts charged with the articulation of 
the sounds, they cannot, for this reason, be 
formed. In mussitation, on the contrary, the 
motions of the speaking organs take place, but 
they are not preceded or followed by any kind of 
vocal sound, even the most feeble. In complete 



92 THE VOICE. 

aphony the sonorous voice is entirely destroyed, 
but the individual can, as is improperly said, 
speak in a low voice, and express his thoughts 
by the aphonic voice at short distances, which is 
not the case in mussitation. 

If, as those pretend who compare the larynx 
to a mechanical instrument, the voice were 
merely the result of the vibrations, which the air 
issuing from the lungs experiences when travers- 
ing the glottis, it would be very difficult to under- 
stand why this admirable organ is altered, or even 
entirely lost in many diseases, although the larynx 
often at the time undergoes no lesion or altera- 
tion, either in its muscles, membranes, or car- 
tilages. These modifications must, however, 
depend upon a cause which requires to be sought 
for ; this cause, in our opinion, can only be a 
new mode of vitality impressed upon the vocal 
organ by the sympathetic reaction of some other 
affection more or less remote. 

It may then be said, that the voice is not a 
simple vibration, but that it is living, and is 
animated like the organs which produce it. The 
voice being the sonorous expression of our senti- 
ments, it must necessarily change with those 
which it expresses ; it must then be modified by 
the diseases which influence the vitality of the 



APHONY AND DYSPHONY. 93 

whole system, or which react, sympathetically, 
upon the vocal organs. 

Dysphony, or difficulty in the emission of 
sounds, and aphony, or complete extinction of the 
voice, are usually symptomatic, and cannot, for 
this reason, be studied by themselves in a practi- 
cal aspect ; but by considering these alterations 
of the voice as being the ordinary symptoms of 
some other affection, it becomes of the highest 
importance to give them the most serious atten- 
tion. 

The aphony which is observed in continued 
ataxic fevers, almost always renders the prognosis 
fatal ; it is the same in adynamic fevers and in- 
flammations complicated with adynamia, in which 
the alterations of the voice, joined to some other 
unfavorable signs, are almost always followed by 
death. The author of the book of the Coacians 
regards as a very bad sign, aphony accompanied 
with great weakness and a high and painful 
respiration. He considered the loss of the voice 
to be even more unfortunate in its influence upon 
the prognosis in acute diseases, especially in 
those which manifested themselves with much 
pain ; it was the same in fevers with convulsions 
and deaf delirium, or rather with delirium and 
dulness. Hippocrates also relates in his book of 



94 THE VOICE. 

epidemics, several observations, which fully con- 
firm the truth of his opinions, and the justice of 
his prognosis. 

When the aphony is sympathetic, in that it is 
derived from a lesion at a distance from the 
larynx and throat, the treatment must therefore 
be studied by seeking to combat the morbid state 
which has produced it, and to discover the sympa- 
thies of the distant organs, which react upon the 
vocal apparatus. If, on the contrary, the altera- 
tions of the voice depend upon a pathological 
state of the speaking organs, properly so called, 
it is evident that the treatment must be subjected 
to the nature of the affection, and that resort 
must often be had either to medicine, or surgery, 
according to the circumstances which will be 
pointed out. 

In mentioning the diagnosis peculiar to each 
sort of affection, I shall establish the means of 
cure proper to be employed, and the therapeutical 
agents which have most frequently succeeded in 
my own hands ; taking care, also, to make known 
my failures, and to point out the danger of several 
empirical methods even now employed. 

To render the study of the affections of the 
voice more easy, I have made a classification of 
them, in which I divide them into four kinds, ac- 



APHONY AND DYSPHONY. 95 

cording as they constitute aphony, or produce 
only dysphony, which consists in a greater or 
less difficulty of emitting the vocal sounds. 



Synoptical Table of the Diseases and Organic Lesions, 
which may cause Aphony and Dysphony. 

First Species. — Idiopathic cases of aphony and dys- 
phony, arising from a physiological, anatomical, or 
traumatic lesion of the vocal organs. 

These may be caused by the inflammations of 
the larynx, by those of the trachea, bronchi, 
isthmus of the fauces, tonsils, uvula, veil of the 
palate ; by laryngeal phthisis, oedema of the glottis, 
thickening of the pharyngo-laryngean mucous 
membrane, atony and paralysis of the muscles of 
the pharynx and larynx, spasm of these organs ; 
by falling down of the uvula, by its division with 
that of the veil of the palate and of the palatine 
bones ; finally, by wounds or contusions of the 
larynx and trachea, or an opening situated below 
the glottis ; finally, by the section or lesion of the 
laryngeal and pneumo-gastric nerves, etc., etc. 

Second Species. — Aphony and dysphony symptomatic 
of certain diseases which affect the whole economy. 

These may be caused by adynamic fevers and 



96 THE VOICE. 

ataxic ; by some worm affections ; by pulmonary 
phthisis ; by aneurism of the aorta which then 
compresses the left recurrent nerve ; by lesions of 
the spinal marrow, excessive swelling of the 
stomach; by apoplexy, hemiplegia, anemia, gen- 
eral weakness, convulsions, epilepsy, hysteria, 
catalepsy, chorea, insanity, cholera, frenzy; acute 
moral affections, such as fear, anger, joy, etc. ; 
finally, by the abuse of ardent spirits, and the in- 
troduction into the economy of some poisonous or 
narcotic substances, etc. 

Third Species. — Sympathetic aphony and dysphony, de- 
pending upon the reaction which results from a 
pathological condition of certain organs more or less 
remote, and having no immediate relation with the 
vocal apparatus. 

These may be caused by a falling down or an 
enlargement of the womb ; by the presence of a 
polypus in the cavity of this organ ; by ulcera- 
tions situated about its neck ; by the state of preg- 
nancy ; by amenorrhea ; by dysmenorrhea ; the 
sudden suppression or the commencement of the 
menses ; by the swelling or inflammation of both 
testicles ; by chronic hepatitis ; a derangement of 
the system of the vena porta, or atony of the 
prima? vise ; finally, by the suppression or diminu- 
tion of a natural or artificial discharge, by perspi- 



APHONY AND DYSPHONY. 97 

ration too long continued or suddenly stopped, 
especially about the feet and cutaneous surface. 

Fourth Species. — Specific aphony and dysphony, result- 
ing from a primitive or consecutive remote affection, 
which has been conveyed to the vocal organs. 

These may be caused by the venereal, scrofu- 
la, scurvy, arthritis, rheumatism, gout, psoriasis, 
herpes ; by nearly all the exanthematous affec- 
tions ; finally, by the ill-managed employment of 
the preparations of iodine and of mercury, which 
sometimes give rise to swellings and ulcerations 
of a peculiar nature. 

As it does not enter into the plan of this work 
to treat of all the general or local affections men- 
tioned in this synoptical table, I warn my readers 
that I shall content myself with simply examin- 
ing the alterations and lesions of the organs pro- 
ducing the voice, taken collectively and separately. 
I shall therefore pass in silence over all the acute 
diseases, as well as all those general affections of 
the second class which affect the whole economy, 
and give birth to symptomatic aphony or dysphony. 
9 



CHAPTER VI. 

CHRONIC SWELLING OF THE TONSILS. 

Among the diseases of the organs which form 
a part of the isthmus of the throat, none is more 
frequent than hypertrophy of the tonsils. The 
chronic swelling of these glands arises from acute 
inflammations and irritations often renewed, which 
at length produce a permanent dilatation of their 
blood-vessels, and consequently a greater quan- 
tity of nutritive materials to these organs. 

This swelling increases in proportion to the 
number of the inflammations of the isthmus of 
the throat. At first, it produces but a slight un- 
easiness in swallowing, and an immaterial altera- 
tion in the voice, especially in the acute sounds 
of the second scale ; but it often happens that 
considerable swelling remains, and then consti- 
tutes hypertrophy of the tonsils, which may be 
carried to such a degree, that these glands touch 
the uvula, and so contract the isthmus of the 
throat, that the emission of sounds is almost im- 



SWELLING OF THE TONSILS. 



99 



possible, and respiration becomes extremely diffi- 
cult. The voice is rendered very hoarse and 
nasal, the pronunciation of words is changed and 
thickened, and persons laboring under this affec- 
tion always speak as if their mouth was rilled 
with food. Another inconvenience of no less 
magnitude is joined to those already pointed out. 
It is, that during deglutition, the food, especially 
liquids, are rejected through the nasal cavities, 
because the veil of the palate, disturbed in its 
functions by the tonsils, the volume of which is 
considerably augmented, cannot raise itself and 
completely close the posterior openings of the 
nasal sinuses. When the disease has reached 
this point it becomes necessary to adopt some 
remedy. We will now mention those which we 
have found to succeed in similar cases. 

If the swelling was not of very long standing 
nor very considerable, as often takes place after 
a prolonged cold, the treatment might be con- 
ducted as in acute inflammations of the tonsils, 
and antiphlogistics should be employed, with 
revulsions and sudorifics taken hot, to which 
might be added, with advantage, some astringent 
gargles. If these measures do not completely 
succeed, there is another which rarely fails in its 
effect, and which promptly reduces the tonsils to 



100 THE VOICE. 

their normal state ; it is cauterisation with the 
nitrate of silver passed over the whole surface of 
these glands. This process, which I have very 
often employed with success, has also succeeded 
in the hands of my friend, Dr. Carron Duvil- 
lards, a young physician distinguished in medical 
practice and literature, and to whom science ow T es 
several important discoveries, especially in regard 
to the therapeutics of diseases of the eyes. If a 
liquid caustic be employed for the cauterisation, 
or a solution of the nitrate of silver conveyed to 
the organs by means of a hair-pencil or lint, care 
should be taken not to take up too much liquid, 
for fear that some drops might fall upon the 
healthy parts of the mouth or throat ; when the 
operation is ended, the patient should be made to 
gargle his mouth with barley-water sweetened 
with honey, in order to remove those parts of the 
caustic which may not have acted upon the dis- 
eased surfaces. 

If the swelling of the tonsils depended upon a 
scrofulous diathesis, as I have seen it in several 
instances, then the antiphlogistic treatment would 
be more injurious than useful ; and previous to 
cauterisation the preparations of iodine might be 
successfully employed, such as frictions with the 
ointment of the hydriodate of potash upon the 



SWELLING OF THE TONSILS. 101 

superior and external part of the neck, corre- 
sponding to the external face of the tonsils ; to these 
measures might be added, gargles made with one 
pint of distilled water holding in solution four 
grains of iodine ; and it will also be of advantage 
to make use of baths of salt and water, or of 
soap-suds, or, better yet, of sea water. At the 
same time may be employed dry frictions upon 
the skin, with wool dipped into some alcoholic 
substance ; to these measures may be added the 
iron mineral waters and bitter drinks of hops and 
gentian ; finally, the treatment will be completed 
by the cauterisation with the nitrate of silver. 

When the swelling is very considerable, and 
possesses the inconveniences which I have pointed 
out above, or when cauterisation and the other 
measures have been employed without effect, as 
in cases of less severity, the tonsils must be re- 
moved. 

Finally, one thing must not be lost sight of in 
the treatment of chronic enlargement of the ton- 
sils, — that to this affection are often joined a 
clammy state of the mouth and frequent dispo- 
sition to vomit. Physicians, even the well-in- 
structed, who have not observed these diseases, 
regard these phenomena as symptoms of an 
irritation of the stomach, which they think them- 
9* 



102 THE VOICE. 

selves frequently called upon to combat, while 
the phenomena observed by them are purely 
local. The clammy and foetid state of the mouth 
depend upon an alteration in the mucosities of 
this organ, in consequence of a morbid secretion 
of the mucous membrane covering the tonsils, or 
from the irritation, which is propagated by con- 
tinuity of tissue over the whole bucco-pharyngean 
mucous membrane. The disposition to vomit 
arises from the consecutive inflammation of the 
uvula, in consequence of the friction of this 
organ against the base of the tongue. This last 
phenomenon will disappear as soon as the tonsils 
have resumed their natural state, or been ex- 
cised. 

The tonsils are also subject to several affec- 
tions which always more or less alter the voice. 
Thus there are sometimes formed in them kinds 
of calculi, the result of a thickening of the mu- 
cous matter and of the crystallization of the salts 
which enter into the chemical composition of the 
mucus ; hence result concretions, which are some- 
times tender and viscous, sometimes hard and 
crystalline, and of a yellowish color. The former 
are capable of being altered and of putrifying in 
the very body of the tonsil, which causes a most 
foetid odor to exhale from the mouth, quite as 



SWELLING OF THE TONSILS. 103 

insupportable to the patient as to those about him. 
The concretions of the second kind, exclusively 
composed of the phosphate of lime, are non- 
putrescent like all the saline concretions. They 
sometimes distend the tonsils in an extraordinary 
manner, and dilate the depressions of these glands, 
so that their openings expand, and even permit 
them to be seen and touched with a pen, when 
the mouth is widely opened. 

One of the symptoms, which indicates most cer- 
tainly that the swelling of the tonsils is due to the 
presence of these calculi, is, that the individuals 
who are subject to them often spit out some frag- 
ments of these concretions, which are detached 
and fall into the throat. If deglutition is ren- 
dered irksome, and the voice is altered in singing 
and speaking, the only way to remedy these in- 
conveniences would be to practise excision of the 
tonsils, as I have once done with success, and 
as was performed by M. Blandin, a short time 
since. 

There are also developed in the tonsils, very 
rarely indeed, true acephalocysts, or vesicular 
worms, which occasion these glands to take on a 
considerable increase, and which is almost always 
confounded with their hypertrophy, properly so 
called. But in this instance the error of diagno- 



104 THE VOICE. 

sis has no inconvenience, especially if excision is 
performed ; for this operation is the only measure 
which can succeed, as I have seen it performed 
by M. Dupuytren. I will relate the case. 

A young man presented himself for the opinion 
of this celebrated and skilful surgeon for an ex- 
cessive enlargement of the tonsils, which altered 
his voice considerably, and greatly impeded deg- 
lutition. M. Dupuytren judged excision of the 
gland to be the best remedy, and the patient, pos- 
sessing the utmost confidence in the skill of the 
operator, immediately requested him to perform 
it. During the incision, a quantity of moisture 
flowed out, and upon the part removed might have 
been perceived the half of a cyst, whose slight 
adhesion, elasticity and opaque color, left no doubt 
as to its nature. The remainder of this vesicular 
sac was extracted with the greatest facility, and 
the operation was followed by a complete cure. 

The tonsils are also subject to some other dis- 
eases, such as cancer, which is incurable and 
happily very rare ; certain abscesses which are 
opened without resorting to art ; finally, ulcera- 
tions of various kinds, which require appropriate 
treatment, of which the size of this work does 
not permit us to speak, but which will be spoken 
of in treating of specific aphony. 



CHAPTER VII. 

ORGANIC PROLONGATION OF THE UVULA, AND PRO- 
LAPSUS OF THIS ORGAN. 

The uvula is a cone-shaped appendix, free and 
floating in the throat. Its apex is turned down- 
wards towards the dorsal face of the tongue, and 
its base is united to the veil of the palate, of 
which it is a prolongation. The length and width 
of the uvula vary with the individual, and its two 
opposite faces present a line which is often quite 
deep. The structure of this appendage, which is 
slightly complicated, encloses a great number of 
mucous follicles; it is formed by the approximation 
of the two muscles, azygos uvula, which are 
sometimes distinct, sometimes confounded as one 
muscle. 

The uvula is covered on all sides by the bucco- 
pharyngeal! mucous membrane, and is formed of 
two lateral parts very distinct in young subjects, 
but united at a later period at the line. In some 
individuals, the two portions of the uvula remain 



106 THE VOICE. 

separated during life, in consequence of an acci- 
dent in their formation, and this division is very 
often continued through the whole extent of the 
veil of the palate. The uvula also may not exist. 
Frequently no inconvenience results from it, but 
more generally speaking, singing in the acute 
notes and deglutition are executed with more or 
less difficulty. 

There are few parts whose sensibility is more 
marked than that of the uvula ; when the sum- 
mit of this organ is irritated by the contact of the 
tongue, or when it is excited by any lively irrita- 
tion, the stomach is sympathetically excited, and 
nausea or even vomiting will result. For this 
reason, when it is desired to increase the action of 
an emetic, the finger is almost instinctively con- 
veyed to this organ, which is likewise sometimes 
tickled for the same purpose with the feathers of 
a quill. 

In consequence of its excessive sensibility, the 
uvula is subject to several diseases, and to fre- 
quent inflammations, which impart to it a degree 
of development, and often, also, a condition of 
prolapse which sometimes passes into the chronic 
stage, and which then constitutes a true hyper- 
trophy of the glandular layer of this organ. At 
other times, this prolongation and morbid develop- 



PROLONGATION OF THE UVULA. 107 

mcnt of the uvula depend upon a submucous 
oedema, which always yields to the action of the 
nitrate of silver. 

The serous infiltration of the uvula is most fre- 
quent in the northern countries with a cold and 
moist climate, and it is usually observed in in- 
dividuals of a lymphatic constitution, and those 
liable to catarrhal affections. It manifests itself 
sometimes suddenly, in consequence of cold 
drinks when the skin is covered with perspiration, 
or after a sudden chill of the entire body, or of 
the feet merely. A young lady of my acquaint- 
ance was attacked with an infiltration of the 
uvula after partaking of an ice at a ball, being 
very hot from dancing. Her uvula had in a 
short time acquired a considerable volume, so 
that it had lost its primitive form, and become 
rumpled, pale and semi-transparent. Cauterisa- 
tions and astringent gargles soon reduced this 
organ to its normal condition, which, however, 
gave her no pain previous to the treatment, but 
merely incommoded her much in speaking, and 
excited a frequent disposition to cough and to 
vomit. In chronic inflammations of the uvula, 
the organ acquires a much smaller size, its color 
is much deeper than in the natural state, and it 
becomes the seat of a sensation of heat and of 



108 THE VOICE. 

smarting, which is propagated from the veil of 
the palate to the neighboring parts, and which 
may, in a great number of cases, cause a com- 
plete aphony, or, at least, a noticeable dyphony. 
In this case, antiphlogistics must first be em- 
ployed ; general bleeding, leeches in great num- 
bers placed upon the verge of the anus, emollient 
injections, hot acidulated drinks, principally tama- 
rind water ; astringent gargles, especially those 
made with the sulphate of alum or of zinc ; the 
application of a large blister to the nape ; general 
baths, foot-baths with the addition of hydrochloric 
acid ; issues on the posterior part of the neck. 
When this inflammatory state of the uvula ap- 
pears to coincide with a suppression of the 
menses or of an hemorrhoidal flux, emenagogues 
may be employed with advantage, especially 
those containing the subcarbonate of iron. Aloe- 
tic purgatives, frictions upon the lower limbs 
may be resorted to ; finally, every measure 
should be tried to combat the disease, whether 
by acting at once upon the diseased organs, or 
upon those of which the natural or artificial dis- 
charges have been suddenly suppressed. 

Venereal ulcerations sometimes affect the 
uvula even to its destruction ; in those cases 
where the presence of the venereal taint is well 



PROLONGATION OF THE UVULA. 109 

established, to the general and local antisyphilitic 
treatment must be added cauterisations with the 
nitric acid upon the ulcerated surfaces, and the 
treatment may be terminated by the mineral 
astringent gargles. 

In consequence of too long continued exertion 
of the vocal organs — as sometimes happens in 
certain professions, for example, among singers, 
orators, players upon wind instruments, public 
criers, etc. — the veil of the palate, and especially 
the uvula, fall into a state of atony, which occa- 
sions, in the latter, a relaxation and prolapsus, 
which may be followed by serious inconveniences ; 
for, as M. Lisfranc observes, there may some- 
times result a fatal laryngeal phthisis, or gastric 
and bronchial irritations, produced and kept up 
by the tickling of the throat by the free and 
floating extremity of the relaxed organ. 

The fall of the uvula, merely from the dis- 
agreeable sensation which it produces by provok- 
ing, as we have already said, a constant desire to 
swallow and to vomit, would always be a great 
inconvenience ; but, in addition, it seriously im- 
pedes, and even completely prevents the modu- 
lation and articulation of sounds in singing, and 
especially in speaking, as is observed by M, 
Bennati, when these acts are successive, as in 
10 



110 THE VOICE. 

prolonged reading, parliamentary speaking, and 
in singing, which is thus rendered impossible. 
There may often result from it a complete and 
permanent aphony from the dry state of the 
throat, and the frequently repeated efforts made 
in speaking. 

In this case, as in those already cited, recourse 
must promptly be had to cauterisation of the 
organ, and to astringent gargles. If, by this 
measure, a speedy change is not soon obtained 
for the better, and the contractile faculty of the 
muscle of the uvula is not sensibly augmented ; 
and if, above all, the individual is not a singer by 
profession, prompt recourse may be had to excis- 
ion of the uvula, which is a speedy operation, 
attended with but little pain. The only incon- 
venience which can result from this operation, 
and that by no means constant, is that of permit- 
ting the nasal secretions to fall more easily into 
the throat, and of preventing, sometimes, as in 
excision of the tonsils, the formation of some 
acute notes of the faucette, or of the second 
scale. In individuals having a base voice, or 
simply a laryngeal voice of the middle scale, 
this latter inconvenience is less to be feared ; at 
any rate, it cannot be compared with those result- 
ing from a prolapsus of the uvula. 



I 
PROLONGATION OF THE UVULA. Ill 

In those who have a division of the veil of the 
palate, the uvula is always divided ; it even 
sometimes happens that one of the halves of this 
organ is more developed than the other, and then 
the separation does not appear to be in the 
middle. When the division is limited to the 
uvula, and the individual experiences but slight 
inconvenience in. the articulation and modulation 
of sounds, an operation should not be attempted. 
If the separation should, however, extend into the 
veil of the palate, as is sometimes the case, the 
inconveniences resulting from it are of so serious 
a nature as to require immediate surgical assist- 
ance by an operation named staphyloraphy. 



CHAPTER VIII. 

CHRONIC INFLAMMATIONS OF THE LARYNX AND 
TRACHEA, AND PRIMITIVE LARYNGEAL PHTHISIS. 

The larynx and bronchi, continually irritated 
by the contact of the air, and the injurious influ- 
ences of heat, moisture, and cold, are, for this 
reason, more exposed than the other organs to 
acute and chronic inflammations. But from the 
nature of this work, we shall treat only of those 
chronic affections which alter the voice, and not 
of the acute, which are often soon fatal, such 
as certain inflammations of the larynx, croup, 
oedema of the glottis, which demand immediate 
relief, and which are rather diseases of the respi- 
ration than of the voice. We think it our duty to 
abstain from speaking of this latter class of dis- 
eases, on the one hand, that we may not wander 
from our subject, and, on the other, that we may 
extend our remarks upon chronic inflammations 
of the larynx, and upon primitive laryngeal 
phthisis, not coincident with any pulmonary 



INFLAMMATIONS, ETC. 113 

trouble. We shall, however, make a few rapid 
remarks upon the acute but slight inflammations 
of the bronchi and larynx, which merely produce 
hoarseness and a little cough. 

These affections, united or separate, are neither 
more nor less than what is commonly called a 
cold, constituting a simple indisposition, which 
scarcely merits the name of sickness ; which^ 
therefore, does not in general attract the attention 
of physicians, or those affected by them. 

The symptoms of a cold are a cough more or 
less severe, hardly painful, and the expectoration 
of some grayish spits, with some passing chills, 
which, with the other phenomena, occasion no 
trouble in the functions of the organs, and almost 
always permit those laboring under them to en- 
gage in their usual avocations. 

If this slight affection is never disquieting, it 
nevertheless presents great inconveniences, espe- 
cially to those whose condition obliges them 
either to speak or to sing in public, for it always 
produces hoarseness, and sometimes even com- 
plete aphony. It will therefore be useful to say 
some words upon the means of preventing it, and 
of curing it as soon as possible, the more so, inas- 
much as it may easily increase in intensity, and 
occasion a chronic or acute laryngitis, unfortu- 
10* 



114 THE VOICE. 

nately too often beyond the resources of medi- 
cine. But as the causes of a cold, and the means 
of preventing it, are nearly the same with those 
of bronchitis and laryngitis, we shall reserve our 
remarks till after we have spoken of this latter 
class of affections, contenting ourselves, for the 
present, with pointing out the course to be fol- 
lowed in combatting a cold and hoarseness. 

These slight shades of bronchitis and laryngitis 
are very frequently cured with the aid of simple 
hygienic precautions, the principal of which are 
the repose of the vocal organs, and the care to be 
taken in avoiding cold and moisture. To these 
measures, which alone are not always sufficient, 
may be added the use of cough mixtures, muci- 
laginous preparations, such as warm infusions of 
violets, of borage, or decoctions of dates, jujubes, 
figs, grapes, etc., sweetened with honey or sugar, 
or with syrups of gums, marsh-mallows, etc., or 
cut up in milk. 

But a measure which almost always dissipates 
a cold, and which causes the hoarseness to dis- 
appear as if by magic, is to endeavor to excite 
a strong perspiration by the administration of 
diaphoretic drinks containing much gum, such as 
an infusion of borage-flowers, of elder, and of 
honeysuckle in equal parts, a handful of each to the 



INFLAMMATIONS, ETC. 115 

pint, with an ounce of gum Arabic, sweetened with 
honey or syrup. These drinks should be taken 
in the evening, some time after eating, and as hot 
as possible, so as to excite the perspiration as 
soon as possible, which will be still more favored 
by retiring to a bed well warmed, and abundantly 
furnished with coverings. I have obtained a 
great number of rapid cures by these diaphoretic 
infusions, the free use of which need not be 
feared. The effect of these hot drinks might be 
further augmented by the addition of one or two 
table spoonfuls of rum or brandy ; but this addition 
is only adapted to those who are in the habit of 
using these liquors, and would prove injurious to 
persons w r ith irritable stomachs. In any case, 
these measures should only be employed at the 
commencement of slight colds, especially when 
it is desirable to put a speedy end to the hoarse- 
ness or aphony, and when the individual is from 
some circumstances obliged to speak or sing in 
public, and it cannot be postponed, as frequently 
happens to singers, comedians, lawyers, etc. 

A milder, more uniform temperature, an abso- 
lute silence, a rigid diet, should be the first condi- 
tions to be fulfilled when the bronchitis invades 
in a more acute and intense manner ; that is, 
when it manifests itself by a strong fever, an 



116 THE VOICE. 

intense headache, full and frequent pulsations of 
the arteries, a violent and painful cough, a sensa- 
tion of burning heat in the chest, chills on the 
surface of the body, a considerable oppression 
and dyspnoea, no expectoration, or the expulsion 
of some bloody spits. The conduct differs in 
this case from that for a slight bronchitis, and 
begins by the employment of blood-letting, cup- 
ping, the pectoral drinks we have already men- 
tioned ; to which may be added the loocho, doses 
of oil, very hot emollient poultices, often re- 
newed, and applied upon the chest. If the 
cough were very painful and convulsive, the 
narcotics might be employed with advantage, 
which should be suspended as soon as expecto- 
ration became easier, and the spits were rendered 
more abundant. 

If, after all, the bronchitis were prolonged, and 
threatened to pass into the chronic state, a large 
blister might be applied with advantage upon the 
chest, or, what has seemed to me preferable, 
friction might be made over the sternal region 
with the ointment of the tartrate of antimony, 
until large varioloid pustules were developed, 
which might be still further irritated by putting a 
piece of flannel upon them. Emollient vapors 
and emetics, recommended by several physi- 



INFLAMMATIONS, ETC. 117 

cians, have always appeared to us inefficacious, 
and even sometimes injurious. 

When the acute bronchitis is prolonged beyond 
twenty or thirty days, without having been re- 
newed by any anterior causes, and when the heat 
in the chest under the breast-bone and the resist- 
ance of the pulse have disappeared, good results 
are often obtained by the employment of aro- 
matic and diaphoretic drinks ; also, about the 
same period, local rubefacients and vesicants are 
applied upon the chest with the most advantage. 

Chronic bronchitis ordinarily arises after re- 
peated colds, or one or more attacks of acute 
and intense bronchitis; the treatment of this 
affection is based in part upon the same founda- 
tions as that of acute bronchitis. Bleedings, 
however, are rarely useful ; for this reason, prac- 
titioners seldom resort to them when the affection 
is ancient. In this case, too gummy and mucil- 
aginous drinks, with a feculent and milky diet, 
give place to decoctions of Iceland moss and 
ground ivy, the internal use of sulphur, of mer- 
cury in small doses and in pills, and balsams, with 
sulphuretted mineral waters. To these measures 
are added, especially among lymphatic persons, 
the moderate use of good old Bordeaux wine, 
and a diet principally composed of roast meats ; 



118 THE VOICE. 

recourse may also be had to dry frictions and 
revulsives ; it is advisable to wear flannel waist- 
coats, woollen socks, and to reside in the country, 
if possible in a chamber exposed to the south. 

The symptoms of chronic bronchitis are re- 
duced, in general, to the cough, expectoration, 
and an alteration in the voice, which varies as 
the inflammation of the mucous membrane is 
more or less prolonged in the direction of the 
larynx. Sometimes chronic bronchitis termi- 
nates in tracheal phthisis. This affection, al- 
though often beyond the resources of medicine, 
may continue for a long time, like laryngeal 
phthisis, without presenting any general appre- 
ciable symptoms ; frequently, too, the general 
condition of the patients, by tranquillizing them 
as to their actual state, induces them to neglect 
their treatment, until they fall as it were of a 
sudden into a desperate condition. If we were 
not to speak of laryngitis, we would add several 
modes of treatment adopted for chronic bronchi- 
tis, but as the measures will be pointed out in 
the treatment of laryngitis, it will be useless to 
speak of them ; we shall, therefore, content our- 
selves with a few words upon the causes of 
bronchitis in general. 

Lymphatic, feeble, exsanguine individuals, who 



INFLAMMATIONS, ETC. 119 

have little vital heat, or who are constitution- 
ally lymphatic, are more subject to attacks of 
bronchitis, and to taking cold, as it is commonly 
called, upon any exposure to the slightest, and 
often the most inappreciable causes. It is the 
same with individuals whom exaggerated pre- 
cautions, resulting from an effeminate and bad 
education, have rendered too impressible to the 
action of external agents. The convalescent, 
those who are weakened by considerable haemor- 
rhage or a chronic disease still existing ; lastly, 
those who have been frequently attacked by 
catarrhal inflammation, are more liable to con- 
tract all the species of bronchitis. 

The most frequent causes of these affections of 
the bronchi are the impression of cold upon the 
whole body, or only upon certain parts, especially 
on the chest, shoulders, arms, feet, etc. The 
impression of cold is the more lively, and its 
action the more prompt, as the body is the more 
heated ; for this reason, the inflammations of the 
bronchi are more frequent during spring and 
autumn, when they often reign epidemically, 
than during summer or winter, when the varia- 
tions in the temperature of the atmosphere are 
less frequent and sudden. 

These affections often also arise from the in- 



120 THE VOICE. 

fluence of the immediate contact of the cold air 
upon the bronchial mucous membrane, as well 
as the influence of that which has an elevated 
temperature, or which is charged with vapors 
or irritating gases, such as chlorine, ammonia, 
acetic acid, nitrous gas, etc. The inspiration of 
air holding in suspension particles of foreign 
bodies, such as dust, charcoal, plaster, lime, 
meal, etc., may also give rise to inflammations of 
the air-passages. But as Laennec has observed, 
the inflammations which are caused by physical, 
chemical, or mechanical agents, are in general 
less severe and less rebellious than these same 
inflammations arising from the other causes men- 
tioned. I have been called upon to treat many 
cases of chronic bronchitis, and cases of this kind 
are more frequent than is commonly supposed. 
The causes of these attacks of bronchitis were 
various ; some arose from the too prolonged exer- 
cise of the vocal organs, as in singing, declama- 
tion, the forced cries of certain professions, etc. ; 
others from various cutaneous eruptions, as 
small-pox, measles, scarlatina, the rash ; to these 
may be added the hooping-cough. They are 
always preceded or followed by a more or less 
severe bronchitis, the invasion of which, as also 
that of the acute exanthematous diseases, is ordi- 



INFLAMMATIONS, ETC. 121 

narily preceded by uneasiness, chills, sneezing, 
loryza, soreness of the throat, etc. 

Our intention in this work being only to treat 
of the affections of the vocal organs properly so 
called, especially of those of the throat, which 
alter the voice or entirely prevent the formation 
of the sounds, we shall here terminate what we 
have to say upon bronchitis, the causes, symp- 
toms and treatment of which we have rapidly ex- 
posed with the view of rendering it more com- 
plete, because, as has already been said, chronic 
inflammations of the bronchi often produce aphony 
or dysphony, while there is no affection of the 
larynx, pharynx, or isthmus of the throat. If the 
voice were a simple vibration of the glottis, it 
would not be altered in bronchitis, although in 
this disease the larynx often experiences no al- 
teration. The aphony which arises in this latter 
case can then only be assigned to a new mode of 
vitality, which exerts its influence upon the glottis 
and the larynx. 

If inflammations of the bronchi often produce 
a change in the voice, there are some cases in 
which this admirable organ always remains more 
or less unaffected; while the slightest inflamma- 
tions of the larynx, especially those of the lips of 
the glottis, always produce more or less dys- 
phony. 



122 THE VOICE. 

As it is with regard to their phonic relation 
rather than their respiratory, that it is our inten- 
tion to examine the diseases of the larynx, it will 
be best for us to pass over in silence all the 
acute alterations, which, in this respect, form 
more properly a part of the affections of the 
organs of respiration, than of those of the voice. 
We shall therefore say nothing about intense 
acute laryngitis, or about croupal and pseudo- 
membranous laryngitis, which present such great 
dangers and are so often suddenly mortal, not 
from the nature of the disease, but from its situa- 
tion. In fact, the larynx serving as a tube for 
the passage of the air, and this tube being con- 
siderably contracted by the approximation of the 
lips of the glottis, it would result that the slightest 
thickening of the mucous membrane, the merest 
layer of mucosity, or pseudomembranous con- 
cretions, might, by rendering the entrance of the 
air very difficult, bring on all the symptoms of 
asphyxia. I will content myself with saying that 
these species of acute laryngitis demand the most 
prompt and energetic measures ; for the least 
delay in their administration is often the sole 
cause of their inefficacy. Large, general, and 
local bleedings should be immediately resorted 
to, derivatives of every kind should be employed, 



INFLAMMATIONS, ETC. 123 

emetics, also, and tracheotomy should be resorted 
to at an early rather than a late period, if the 
symptoms seem to grow worse rapidly. This 
latter operation has often failed because of too 
long delay before resorting to it. Chronic laryn- 
gitis may be consecutive to an acute laryngitis, 
but it more often begins in the chronic form after 
extreme fatigue and long-continued use of the 
organ of the voice, and is kept up by the repeated 
exercise of this organ required by certain pro- 
fessions. In some cases it is primitive, and 
entirely independent of pulmonary phthisis; it 
then takes the name of primitive laryngeal 
phthisis, to distinguish it from laryngeal phthisis 
consecutive to a pulmonary affection, of which it 
is a symptom, and therefore called symptomatic 
laryngeal phthisis. 

Laryngeal phthisis may then exist alone, with- 
out coinciding with pulmonary phthisis ; it may 
therefore be primitive. No doubt can remain 
with regard to this, when it is considered that a 
certain number have been cured, some cases of 
which I have seen. Moreover, in the autopsies 
of a few individuals, who have succumbed to a 
laryngeal phthisis, I have found pulmonary 
tubercles in their native or crude state, which 
could not certainly have exerted any influence 



124 THE VOICE. 

upon the course of the disease. I might here 
add another argument in favor of this opinion, 
that certain forms of phthisis called specific, such 
as laryngeal venereal phthisis, etc., are developed 
and run their courses independently of any pul- 
monary affection. 

There is, then, no doubt but that laryngeal 
phthisis or ulcerating laryngitis may be developed 
suddenly, or be consecutive to a chronic laryn- 
gitis, very frequently coinciding with the general 
symptoms of a pulmonary phthisis, the principal 
of which are, hectic fever, night sweats, swelling 
of the legs, diarrhoea, etc., etc. ; the local symp- 
toms of primitive laryngeal phthisis, etc., are, the 
alteration of the voice or complete aphony, a 
dry painful cough, often convulsive and accom- 
panied by the vomiting of purulent or at least 
puriform matters. The cough increases by 
night, and the patient is often awakened, by the 
suffocation he experiences. There is joined to a 
fetid breath a great difficulty and a quick pain 
in swallowing the food, both liquid and solid ; 
deglutition is followed by violent attacks of 
coughing, and the unfortunate patients sometimes 
require to be nourished by means of an sesopha- 
gean tube. Such are the local and general 
symptoms of primitive laryngeal phthisis, and of 



INFLAMMATIONS, ETC. 125 

laryngeal phthisis consecutive to a pulmonary 
affection ; as the latter always terminates in 
death, and as we are only concerned with the 
primitive and curable laryngeal phthisis, and 
with simple chronic laryngitis, which is also 
curable, we will content ourselves with speaking 
only of these two diseases which present a 
chance of cure. 

As we have already pointed out the symptoms 
of curable and incurable chronic laryngitis, we 
will now expose those by which this simple and 
primitive disease manifests itself. At first the 
voice is very much altered, and its emission is 
always more or less painful and often impossible. 
The patients experience in the region of the larynx 
a sensation of uneasiness, accompanied with a 
dry cough, or followed by the expectoration of 
guttural mucosities which often bring with them 
the small tonsillary concretions we have men- 
tioned. This condition may last a long time 
without presenting any general symptoms, and 
frequently the patients, deceived by an apparent 
condition of general health, neglect all the 
therapeutical measures prescribed them, and 
allow the disease to go on until it is beyond the 
reach of medicine. 

Most of those attacked with this disease, fall 
11* 



126 THE VOICE. 

victims to it at the moment when they least expect 
it, because their death is still further accelerated 
by the oedema of the glottis or oedematous laryn- 
gitis, which is simply an acute inflammation of 
the submucous cellular tissue of the vocal cords. 
If such a fatal termination is the almost constant 
result of chronic laryngitis when it has reached 
an advanced stage, it is not so with this affection 
taken in season, and in a great many cases thera- 
peutical agents may be opposed to it, the more 
efficacious if the disease is attacked at its very 
outset. 

The diagnosis of primitive laryngeal phthisis 
is of the highest importance ; the physician 
should especially examine with the utmost care 
by means of the stethoscope the condition of the 
lungs, and explore directly, by means of the 
sight and touch, all the parts constituting the isth- 
mus of the throat ; as, the uvula, veil of the pal- 
ate, tonsils, columns, epiglottis, and even the 
superior opening of the larynx. 

As these affections are often the sad result of 
too long exercise of the vocal organs, and as they 
have nearly the same causes which we have as- 
signed to bronchitis, I shall, in order not to render 
myself tiresome by repetition, pass them over in 
silence, that I may the more readily arrive at the 



INFLAMMATIONS, ETC. 127 

most important part, which is the therapeutical. 
Although the treatment of chronic laryngitis and 
laryngeal phthisis has never been fixed upon in a 
positive manner, I will point out the principal 
measures which seem to me best adapted to com- 
bat these two affections. 

An absolute silence should first be directed, and, 
in order to leave the affected organs as much as 
possible in repose, the patients should be re- 
quested to resist the disposition to cough as much 
as they can. It would be happy for them if they 
could in these cases suppress the cough as they 
can the speech, which can be supplied to a cer- 
tain point by signs and writing. 

Recourse may be had to flying blisters, moxas, 
small cauteries, and what has appeared to me 
preferable and from which I have obtained very 
good results, to frictions upon the sides of the 
larynx, with the ointment of the tartrate of an- 
timony, till the pustules are formed. Small 
bleedings from the arm, to the amount of a quar- 
ter or half a porringer, the applications of leeches 
to the sides of the larynx, scarifying cups upon 
the nape or to the lateral parts of the neck, will 
act, at the same time, as derivative and antiphlo- 
gistic measures. ' Finally, the inspiration of the 
vapor of tar water, and especially of that of a 



128 THE VOICE. 

solution of creosote water, made with one scru- 
ple of creosote to four ounces of water, may be 
employed with advantage. This latter measure 
which I have employed with advantage, and which 
modifies and very quickly in some cases cica- 
trises over chronic ulcers of a bad character, 
requires to be employed a great number of times, 
and to be studied with the greatest attention, 
that positive conclusions may be drawn with re- 
gard to its efficacy in the treatment of ulcerat- 
ing laryngitis. Such observations perhaps I shall 
have the advantage over every other person in 
making, from the care which I have taken to 
mark the effect of this new therapeutical agent in 
chronic diseases of the larynx. During the treat- 
ment of these guttural affections, the patients 
should be restricted to a soothing regimen com- 
posed of porridge, gelatinous broths, feculent or 
other articles of diet which should have as nearly 
as possible the consistence of pap, in order to 
render the deglutition easier and less painful . 
finally, the same measures may be pursued to- 
wards the patients as were pointed out in the 
treatment of chronic bronchitis. 

When primitive ulcerating laryngitis resists the 
measures we have recorded, there yet remains 
another which we have never employed, but 



INFLAMMATIONS, ETC. 129 

which appears to have met with the greatest suc- 
cess in the hands of the Irish surgeon Carmichael. 
This measure which we should hesitate to adopt, 
regarding it as the only means of safety from a 
certain death, is tracheotomy performed in the 
manner recommended by this celebrated surgeon. 
As this operation is very important in its results, 
we deem it a duty to refer the reader to the 
original article in The Dublin Medical and Sur- 
gical Journal, for 1833. 



CHAPTER IX. 

SYMPATHETIC APHONY AND DYSPHONY. 

The secret of the sympathies is evidently the same with that of 
the nervous action. 

Before speaking of the sympathetic vocal 
alterations, we will say a few words rapidly with 
regard to what is understood in medicine by sym- 
pathy, a word derived from the Greek tivv, ivith ; 
and Tia&o;, disease or pain. 

In physiology and in therapeutics, the word 
sympathy expresses the relation of two or more 
organs more or less remote, which establish be- 
tween them a kind of association, by means of 
which the vitality of the one is modified by the 
morbid or physiological condition of the others. 

There exist, then, sympathetic bonds which im- 
press vital modifications upon one or more remote 
organs, when an impression has been received by 
some other organ. These modifications not being 
shared by the intervening parts, cannot be referred 
to the mechanical connections, or to the ordinary 



SYMPATHETIC APHONY, ETC. 131 

routine of the functions, but appear to depend 
upon a certain peculiar organization, which causes 
to vibrate in unison all the organs disposed so as 
to irradiate the impressions which they receive, 
whether directly by the anastomosis of the nerves, 
or indirectly by the intervention of the brain. 
But as the secret of the sympathies is still cov- 
ered with a veil as thick as that which conceals 
the nervous action, we shall not attempt to render 
any explanation of it, desiring to content our- 
selves with speaking of the sympathies which 
produce aphony and dysphony. 

All physiologists, ancient and modern, have 
noticed the sympathy which exists between the 
sexual organs and the larynx, not only during the 
healthy but also during the pathological condition 
of these organs. To this sympathy must be at- 
tributed the change in the voice, the faucette of 
the eunuch, the melodious singing of the birds in 
the season of their loves, the inconvenient spasm 
experienced by hysterical women in the throat 5 
finally, the acerbity of the saliva of animals 
during connection and in the rutting season, 
which renders their bites at this period so dan- 
gerous. 

It has also been shown by the observations of 
Dr. Desgranges, of Lyons, that the individuals 



132 THE VOICE. 

most addicted to the pleasures of love, are also 
the most liable to inflammations of the larynx, 
tonsils and throat. Besides, is it not known, that 
insanity in man is very often accompanied by a 
painful priapism, and that priapism in its turn 
may develop all the symptoms of insanity ? I 
will here relate a curious fact told me by M. 
Delpech, while I attended the lectures of this dis- 
tinguished professor. 

A patient in the venereal hospital of Montpe- 
lier was suddenly attacked with a complete 
aphony succeeding a syphilitic swelling of the 
testicles ; without attending to the loss of the 
voice, the venereal orchitis was treated in a 
rational manner, and the voice gradually returned 
as the swelling of the testicles disappeared. I 
had an opportunity to observe a similar fact 
three years since, the particulars of which were 
published at the time. 

To the conclusive facts just mentioned, it may 
also be allowed me to add, that almost without 
exception all physicians know and have likewise 
observed the sympathy which exists in woman 
between the womb and the organ of the voice. 
Thus, during pregnancy, on the approach of the 
menses, during their flow or at their cessation, 
certain women, especially those of a nervous 



SYMPATHETIC APHONY, ETC. 133 

temperament, experience more or less remarka- 
ble changes in the timbre and force of the voice. 
Facts of this kind are too numerous and too well 
known to require the citation of particular cases. 

A sympathy in general less known and far less 
appreciated, although not less well established 
than those already mentioned, is the sympathy 
which exists between the larynx and the digestive 
and biliary functions. Thus, as I have found it 
in several instances, the voice may be altered by 
the want of action in the intestinal canal, by 
worms, by a derangement in the system of the 
vena porta. Aphony has also been known to 
arise from an acute or chronic inflammation of 
the liver, or from the abuse of injections or dras- 
tic purgatives ; finally, the use of antiherpetic, 
antipsoric, antisyphilitic, and antiscrofulous oint- 
ments, which have often occasioned a complete 
aphony, proves the same as when it arises from 
the -suppression or too long continuance of the 
perspiration, whether upon the feet or upon the 
whole surface of the body ; all these facts prove 
the sympathies which exist between the vocal 
organs and the cutaneous system. 

From the remarks upon sympathetic aphony 
it will readily be seen that, in order to combat 
this form, the physician must not seek to apply 
12 



134 THE VOICE. 

therapeutical measures directly to the vocal or- 
gans, but must aim to discover the organs which 
react sympathetically, in order to struggle against 
the morbid or pathological condition which pro- 
duces the reaction. Thus, the aphony caused by 
a prolapsus- or an ulceration of the womb, would 
disappear in the one case by the application of a 
pessary, and in the other by the cauterisation of 
the neck of the womb. That occasioned by a 
suppression of the menses or a hemorrhoidal 
flux yields to the recall of these evacuations ; in 
the former case, by means of local baths, bleed- 
ings, leeches to the vulva, aromatic vapors, chaly- 
beate preparations, and all the exciting emmena- 
gogues ; in the second, by means of leeches to 
the arms and aloetic purgatives, etc. 

It is the same with every sympathetic aphony, 
the treatment of which should be modified by the 
practitioner according to circumstances ; his own 
experience and medical sagacity should supply 
all that it would be useless and too lengthy to 
detail in this place, for the therapeutics of the sym- 
pathetic vocal alterations will necessarily present 
variations, depending upon the transitory or per- 
manent nature and action of the causes, which 
may have reacted sympathetically. It is there- 
fore necessary to seek out these causes, and to 



SYMPATHETIC APHONY, ETC. 135 

examine them scrupulously : upon a knowledge 
of them almost always depends the cure. We 
will only add, that while the physician is engaged 
in treating the organs which have occasioned the 
sympathy, he must not lose sight of the vocal 
organs, but should the more attentively observe 
them because the efficacy of the general meas- 
ures which he has employed may often be in- 
creased, if the treatment is completed by astrin- 
gent gargles of the sulphate of alum, made in 
the proportion of one part of this salt to sixty 
parts of distilled rose-water. 

In the expectation that, by a more attentive 
observation of our economy, more certain ideas 
will be gained upon the different relations and all 
the sympathetic connections of the organs of the 
voice, it seems sufficient to point out the principal 
without seeking to explain the physiological mys- 
tery which gives them birth, or to discover the 
vital laws in virtue of which they manifest them- 
selves. 



CHAPTER X. 

SPECIFIC APHONY AND DYSPHONY. 

" He who knows can also cure." 

Hippocrates. 

Before speaking of the treatment of the spe- 
cific lesions of the voice, I shall say a few words 
as to my meaning of the term specific aphony. 
In my opinion, the term specific, when applied to 
diseases in general, indicates those which are 
developed in consequence of a special vice, sui 
generis, which fixes itself primitively or consecu- 
tively upon one organ in particular. From this 
definition of the word specific, pathologically 
speaking, will easily be comprehended the affec- 
tions which I would designate as specific aphony 
and dysphony. 

Thus the venereal, scrofulous taints, and all 
the chronic eruptive diseases, which it is useless 
to name, may, by a displacement of their morbific 
agent, be transferred to some organ in particular, 
or without quitting the seat of their devastations, 



SPECIFIC APHONY AND DYSPHONY. 137 

may extend more particularly tipon certain parts, 
which, in the majority of cases, escape. A 
specific aphony is, then, that condition, in which 
a particular morbid taint, losing in some sort the 
type which ordinarily characterises it, carries its 
ravages against the vocal organs, and prevents 
them, by its unhappy influence, from performing 
the admirable part which nature has assigned to 
them. 

It is thus that the syphilitic virus, which ordi- 
narily is circumscribed and fixes itself in prefer- 
ence upon the genital organs, with which it is 
brought in contact, may attack the vocal organs, 
and occasion aphony or dysphony, either by 
changing their mode of vitality, or by destroying 
some of their parts. This accursed devastator, 
engendered by vice and corruption, may, un- 
fortunately, in some cases, attack innocence and 
virtue. A case occurs to me of a young man, 
who contracted a laryngitis, and had afterwards 
venereal aphony, for having played on the horn 
with the mouthpiece of his master, who was 
laboring under this disease. A mercurial treat- 
ment, by my direction, soon caused this primitive 
affection to disappear, which, although there were 
no traces of ulcerations apparent, yet occasioned 
12* 



138 THE VOICE. 

a very lively sensation of heat in the throat, and 
also a complete extinction of the voice. 

There may, then, exist a venereal aphony ; 
and, if the experience of every day did not forbid 
the existence of this affection to be doubted, I 
might bring forward a great number of cases 
capable of removing all uncertainty in regard to 
it. I have also had an opportunity of treating, 
by mercury and sudorifics, and thus perfectly 
curing, an old soldier, thirty-four years of age, 
reduced by a syphilitic laryngeal phthisis to the 
last degree of marasmus, with continued hectic- 
fever and night-sweats. No one had ever before 
suspected a venereal cause for this affection, 
which would soon have proved mortal, if the 
confessions of the patient, and a slight tonsillary 
ulceration of a suspicious nature had not put me 
upon the real traces of the origin of this disease. 

Venereal laryngeal phthisis is very easily 
recognised, when the disease has commenced on 
the genital organs, or when it is manifested by 
other symptoms as plain, such as exostoses, 
caries, glandular enlargements, etc. ; in this case, 
the physician pronounces with certainty. But if 
the syphilitic taint commences its ravages at the 
very first upon the larynx and the other vocal 
organs, difficult or impossible to be explored, the 



SPECIFIC APHONY AND DYSPHONY. 139 

diagnosis then requires a very skilful and ex- 
perienced practitioner. In this case, he must 
interrogate the patient, with the view of profiting 
by his confessions, and examine, with the most 
scrupulous attention, the tonsils, mouth, tongue, 
veil of the palate, in short, all the vocal organs in 
sight ; particular attention should be given to the 
pustules and chancres, the ulcerated surface of 
which is of dirty white, with the edges thickened, 
hardened, ragged and perpendicular. The gums 
should be carefully examined to see if they are 
spongy, and with red and inflamed borders. An 
examination must also be made to ascertain, if 
the glands are not the seats of indurations and 
suspicious spots ; in short, if there cannot be 
found on them transparent pustules, covered with 
scaly crusts, etc. ; if all these symptoms are 
joined to those which we have already pointed 
out as the means of recognising primitive 
laryngeal phthisis, the physician may pronounce 
with certainty, that the aphony he is called upon 
to treat is of venereal origin. 

It often happens, that the veil of the palate, 
uvula, tonsils, and all parts of the isthmus of the 
throat are equally the seat of ulcerations of a 
syphilitic nature, although there may not be any 
affection of the larynx or trachea ; there is, then, 



140 THE VOICE. 

only dysphony, especially in the acute sounds of 
the faucette, and the patients speak as if they 
had a division of the uvula, or an enlargement of 
the tonsils. I have observed in the venereal 
hospitals, that all those who presented ulcerations 
on the veil of the palate, even without perfora- 
tions, had only a dysphony in the articulated 
speech and singing of the first scale, while fre- 
quently, in the same individuals, might be remark- 
ed a relative aphony ; that is, an aphony which 
took place only in some of the high notes of the 
second scale. This observation also militates in 
favor of my theory upon the mechanism and 
formation of the acute sounds of the faucette. 

The venereal taint may also attach itself to the 
bronchial glands, and extend over the whole 
mucous membrane of the trachea, so as to give 
rise to a venereal bronchial phthisis, from which 
frequently results dysphony, and sometimes even 
complete aphony. In this latter case, and in the 
others we have mentioned, the practitioner should 
promptly resort to the therapeutical agents, which 
the experience of several centuries, and the testi- 
mony of the best physicians, have presented as 
best specifics to neutralize the action of the 
disease, and arrest the ravages which mark its 
presence. 



SPECIFIC APHONY AND DYSPHONY. 141 

Let, then, ignorant and unfaithful men attack 
the mercurial preparations, as quacks are al- 
lowed to employ their puffs, or to defile the walls 
and newspapers to cry up other remedies; in 
spite of the various and often opposite opinions, 
which have been put forth in favor or against 
mercury, the preparations of this metal present to 
us the surest guarantee of our desires. I will not 
stop to describe the different modes of adminis- 
tering mercury, whether by frictions on the 
endermic method, or internally; but I will merely 
add, that the bi-chloride, (corrosive sublimate,) 
taken in the form of a pill, and combined with 
the gum guiacum and the gummy extract of 
opium, has appeared to me the mode of adminis- 
tration which, on the one hand, least fatigues the 
patient, and, on the other, presents more fre- 
quently and more constantly happy results. 
Each pill, as I employ them, is composed in 
the following proportions, from the formula of 
Professor Dupuytren: 

Gum Guiac, 2 grains. 

Gummy Extract of Opium, 1-3 of a grain . 

Bi-chloride of Mercury, 1-6 of a grain. 

Of which one, night and morning, may be 
employed at first, afterwards two, increasing one 
at each time, every fifth day; but the number 
should never exceed four, twice a day, till the 



142 THE VOICE. 

treatment is completed. During the use of these 
pills, gargles may be employed of barley-water, 
sweetened with poppy-syrup, to which may be 
added two teaspoons of the* liquor hydrargyri 
bi-chloridi to a tumbler of the liquid ; but the 
addition should only be made at the moment of 
using it, to avoid the decomposition of the mer- 
curial salt. Finally, to these measures may be 
joined a ptisan of sarsaparilla or guiacum, and a 
mild regimen, in strict accordance with the rules 
of hygiene. Even when a syphilitic cause is 
plainly recognised, the employment of the mer- 
curial preparations must not be resorted to with- 
out reserve ; their use demands much prudence, 
and commands the strictest precautions ; for often 
have patients hastened their death by an ill-judged 
treatment, when they thought to escape it. In 
the cases aggravated by the use of mercury, the 
ptisan of feltz may be tried with advantage, the 
sudorific syrups and ptisans of guiacum and 
sarsaparilla. 



CHAPTER XL 

SCROFULOUS APHONY AND DYSPHONY. 

There may likewise exist a scrofulous aphony, 
or, at least, a dysphony, requiring a particular 
kind of treatment, which we shall rapidly explain, 
after having said a few words upon the general 
and local symptoms which indicate the vocal 
alterations of this nature. 

We mean by scrofulous aphony, that which is 
caused by a lesion residing in the vo $al organs, 
and developed in consequence of a scrofulous 
taint. Among the affections of this class, which 
may cause alterations in the voice less rarely 
than is generally supposed, are found induration 
and hypertrophy of the tonsils, glandular mucous 
inflammation of the larynx and bronchi ; finally, 
certain chronic discharges of the bronchi and 
trachea, and, frequently, the thickening of the 
mucous membrane of all the vocal organs. 

Being desirous to avoid any interruption of the 
plan originally proposed, I shall not undertake in 



144 THE VOICE. 

this place to speak of the nature, causes, and 
varieties of scrofulous diseases ; neither shall I 
attempt to indicate all the denominations, by 
which nosographists have designated all the 
affections of this species ; I suppose the reader is 
acquainted with their signification. Moreover, as 
I had nothing to add to what I have found in all 
the medical treatises, I have thought it best to 
pass by this subject, and to content myself with 
speaking only of the diagnosis and treatment of 
scrofulous aphony. 

The diagnosis of the vocal affections of this 
nature is in general very difficult ; and if the 
physician succeeds in establishing their presence, 
in a manner sufficiently positive to permit him to 
act with certainty and confidence, it can only be 
by frequent practice and the most scrupulous 
examination. 

To render our remarks upon scrofulous aphony 
more in order, we will point out the symptoms 
which aid in distinguishing it from those having 
a different cause. We divide these symptoms 
into two classes; the first are furnished by the 
external appearance of the patient and the state 
of the functions in general ; the second, by the 
exploration of the vocal organs and the origin of 
the disease. 



SCROFULOUS APHONY, ETC. 145 

The scrofulous constitution is manifested exter- 
nally by the appearance of a very delicate skin, 
transparent and clear, of a dull white, and sprin- 
kled with freckles, especially on the face ; the 
limbs are cold, small and weak ; the joints large, 
the flesh soft and flaccid ; the form rounded and 
of little elegance ; the cellular tissue, by its great 
development, effaces the prominence of the mus- 
cles ; the face is full, the features are delicate ; 
and almost always a rosy color upon the cheeks 
forms an agreeable contrast with the whiteness 
of the complexion, and gives an appearance of 
health, which deceives people in general, but 
never the observant practitioner. The eyes are 
in general large, widely opened and sensible to 
the light ; the look expresses mildness and ten- 
derness, and the expression of the face almost 
always bears the impression of sadness and mel- 
ancholy ; the wings of the nose are swollen, the 
nostrils red, shining, often excoriated internally ; 
the lining membrane is often irritated, and grows 
thicker and thicker ; the mucous membrane of 
the pharynx is sometimes the seat of the same 
lesions, which affect the voice and render it harsh 
and nasal ; the lips are swollen, especially the 
superior ; the gums are soft, the lower jaw is 
greatly developed in the transverse direction ; the 
13 



146 THE VOICE. 

hair is fine, light, sometimes red, seldom black. 
The neck is rounded, the lymphatic ganglions in 
general, especially those of the jaw and cervical 
regions, are usually hard, round, and roll under 
the fingers. Such, in a few words, are the princi- 
pal symptoms furnished by the physical condition 
of the patients. 

We shall now present the symptoms, which are 
furnished by the condition of the functions. In 
persons afflicted with a scrofulous constitution, the 
digestive functions are often painful and irregular ; 
the absorbent functions seem, on the contrary, to 
increase ; the secretions are inactive, especially 
the cutaneous perspiration ; respiration is per- 
formed in a painful manner, and the voice, even 
when the organs which produce or modify it, are 
not particularly affected, is almost always more or 
less hoarse or shrill. I am far from thinking, 
that those who labor under a scrofulous taint will 
present all the characters I have mentioned. It 
is enough to recognise a certain number of them ; 
and, if I have mentioned them at some length, it is, 
that my readers may not lose sight of them in 
the diagnosis, frequently uncertain, of scrofulous 
aphony and dysphony. 

The organization of individuals merely predis- 
posed to the disease in question, presents, as has 



SCROFULOUS APHONY, ETC. 147 

been shown, characters, in which the physician 
cannot be mistaken, although it only manifests 
itself under the appearance of freshness and 
health. This organization, then, may be modified 
by many circumstances, and often the unhappy 
effects which are developed under the influence 
of this cause, at first exert their destructive influ- 
ence only upon certain organs, to attack subse- 
quently the whole economy, and to carry ravage 
and trouble to all the functions. 

If the scrofulous condition have invaded the 
whole organization, it may in some cases develop 
only local affections, which authors have de- 
scribed as being the principal disease, while they 
are but irritations and inflammations in conse- 
quence of the scrofulous condition. These irri- 
tations are developed in different parts, and vary 
with the nature of the tissues, in which the lesions 
manifest themselves. Most practitioners not hav- 
ing made this important distinction, do not per- 
ceive the scrofulous disease till there are present 
swellings in the throat, caries, etc., etc. The 
result has been, that no effort has been made to 
combat the disease, until it has been allowed to 
invade the entire organization, and has exercised 
great ravages in the whole animal economy. 
The object, then, should be less to combat the 



148 THE VOICE. 

symptoms of the local affections, which are but 
secondary, than to attack the causes and origin cf 
the disease. 

Thus, when an individual affected with an 
alteration in the voice presents most of the char- 
acteristics indicating a scrofulous condition, he 
should be examined with the greatest attention, to 
ascertain, as far as possible, if his affection does 
not depend on one of the causes already men- 
tioned, or which will be made known in another 
chapter. If, for example, the tonsils are hyper- 
trophied without being the seat of pain ; and if the 
swelling is old, and not the result of several suc- 
cessive acute inflammations ; finally, if it presents 
upon its surface small projections or patches of a 
violet red, which are almost always indolent ; in 
this case the physician may pronounce with cer- 
tainty, that the alteration of the voice is caused 
by a scrofulous affection. The diagnosis will be 
corroborated, if the mucous membrane of the 
pharynx has a livid and marbled aspect, and if 
the patient, without experiencing any heat and 
almost no pain in the pharynx and bronchi, joins 
to it a mucous discharge, so abundant and fetid 
as to cause him to expectorate frequently. This 
discharge is the result of the local scrofulous irri- 
tation of the mucous membrane lining all the 



SCROFULOUS APHONY, ETC. 149 

vocal organs ; it constitutes an actual strumous 
bronchorrea, which may even lead to pulmonary 
phthisis. In some cases, on the contrary, in the 
place of this bronchial discharge the mucous 
membrane becomes dried and thickened, so that 
by a change of vitality it gives rise to a complete 
aphony, which is often beyond the resources of 
art. 

To combat the aphony arising from the lesions 
mentioned, great care must be taken to avoid the 
antiphlogistic treatment, especially as regards 
general bleedings, which would be dangerous, 
and always aggravate the disease. The anti- 
scrofulous remedies should first be employed, 
particularly iodine taken in its different forms ; 
at a later period the baths of soap and water will 
be prescribed, or, better yet, of salt and water, 
or of sea-water, combining them with solutions 
of gelatine ; ioduretted gargles may be advised, 
or of the iodide of zinc, which are at the same 
time antiscrofulous and astringent. These gar- 
gles should be prepared according to the formula 
given hereafter. At the end of the treatment, 
these measures may be supplied by gargles of 
alum, which should be continued for some time, 
and frequently renewed. Finally, to add to the 
efficacy of the treatment, tonics may be pre- 
13* 



150 THE VOICE. 

scribed, such as the extracts of gentian, bark and 
centaury, the preparations of iron, ptisans of hops, 
the juices of the cruciferous herbs mingled with 
those of the bitter plants, the Lisbon diet drink, 
the resinous excitants, such as tar, tincture of 
bark, etc. Frictions of the hydriodate of potass 
may also be employed upon the anterior and 
lateral parts of the neck, dry frictions of the skin ; 
and care should be taken to alternate the different 
kinds of tonics and excitants with each other, to 
prevent the patients from becoming habituated to 
• the action of the same substances, which would 
thus soon lose their effect. If any particular 
accidents or general symptoms should arise in the 
course of the treatment, every thing must be sus- 
pended, and even antiphlogistic measures, or any 
others indicated, be resorted to, exactly as would 
be employed if the patient were not affected with 
scrofula. 

The kind of diet which agrees best is the most 
substantial and tonic. Boiled or roast meats, 
eggs, claret wine, should constitute the basis of 
the nourishment : to these may be added, how- 
ever, with advantage, the moderate use of salads, 
of the farinaceous greens, and very ripe fruits. 
In short, the physician will vary the treatment at 
pleasure and according to circumstances, provided 



EXANTHEMATOUS APHONY, ETC. 151 

he does not forget that it is not the aphony 
which he should seek directly to combat, but 
rather the scrofulous condition, which is the first 
cause of it. 

There yet remains for me, before finishing this 
chapter, to speak of aphony from chronic erup- 
tive diseases or scurvies, which are developed 
either by metastasis, or sympathetically. But as 
on the one hand these vocal affections are very 
rare, and as their treatment requires to be con- 
ducted in the same manner as that of other cases 
of specific and sympathetic aphony, I shall con- 
tent myself with speaking of them briefly, and 
add, that the chief object of the physician should 
be to endeavor, either to combat directly the spe- 
cific vice, which is the origin of the disease, or 
first to recall the morbid agent to the parts which 
it has abandoned, to attack it afterwards by all 
the measures presented by therapeutics, as proper 
to arrest its course and completely eradicate it. 

CHRONIC EXANTHEMATOUS APHONY AND DYSPHONY. 

The word exanthem was employed by the 
ancients and also by the moderns, to designate 
every kind of acute or chronic eruption of the 
skin. An exanthematous aphony is, then, that 
which results, either from the transition or exten- 



152 THE VOICE. 

sion of an exanthem, or from its sympathetic re- 
action upon the vocal organs. 

I shall not stop to explain these transitions, ex- 
tensions, or sympathetic reactions, neither can I 
attempt to point out the treatment adapted to each 
species of exanthematous aphony ; such a course 
would be wearisome from its length, without pre- 
senting any advantages. I shall, therefore, con- 
tent myself with saying, that the first principle in 
the treatment of this kind of disease of the voice 
consists in producing the reappearance of the 
cutaneous eruption, by recalling the symptoms of 
tetter or psoriasis, etc. ; after which, all the vocal 
accidents will disappear, and the specific voice 
may be combatted by the measures which expe- 
rience has proved to be the most efficacious. If 
the disease should be neither the result of a me- 
tastasis nor of a sympathy, but rather of an exten- 
sion of the disease, it should be combatted directly 
and by a local irritation of the skin, to endeavor 
to free as soon as possible the vocal organs from 
the irritation seated in them. To attain this object, 
blisters may be employed in the cervical regions, 
hot sudorific drinks sweetened with honey and 
acidulated with a few drops of the acetate of am- 
monia, friction of the skin, and baths of soap and 
water; baths of sulphur may afterwards be resort- 



CHRONIC SCORBUTIC APHONY, ETC. 153 

ed to, and the other measures too well known to 
require that I should point them out in this place. 



CHRONIC SCORBUTIC APHONY AND DYSPHONY. 

This species of aphony, very rare, and almost 
always incomplete, is the result of a chronic 
scorbutic affection which has been badly treated, 
and not completely cured. The patients, who 
are attacked with an alteration of the voice de- 
pending upon this vice, without presenting all the 
ordinary symptoms of scurvy, are, nevertheless, 
easily recognised ; first, because they never fail 
to speak of their old disease, and again, because 
they usually present the following lesions : 

On inspection of the vocal organs, the tongue, 
the veil of the palate, and the sides of the mouth, 
are often found more or less tumid, and of a 
deep, almost livid color ; the cheeks are also 
swollen, and bleed upon the slightest friction; 
lastly, the laryngo-pharyngean mucous mem- 
brane is often covered with ulcerations and 
aphthae, which prevent the ready motions of the 
pharynx, and, by changing the mode of vitality 
of the mucous membrane, necessarily produce 
dysphony and even aphony. In addition to these, 
are the paleness and tumidity of the patients, 



154 THE VOICE. 

their weakness, and the infected odor of the 
breath. 

The treatment, which is that of scurvy, consists 
in taking aromatic baths, in making use of acid- 
ulated drinks, of decoctions composed of gentian, 
wild chicory, hoarhound, fumitory, elecampane, 
etc., with the addition of some grains of the 
carbonate of soda, the tinctures of bark, decoc- 
tions of tan, and especially of the following 
gargle : 

Decoction of Oak Bark, 1 pound. 

Distilled Rose-water, 4 ounces. 

Sulphate of Alum, 2 drachms. 

The decoction of oak bark is made in the pro- 
portion of an ounce of bark to a quart of water. 
This gargle may be sweetened with syrup of 
raspberries, gooseberries, lemon or orange flow- 
ers. The diet should be composed of roast 
mutton and beef, red fruits, claret wine, goat's 
milk, etc. Promenades, diversions, and change 
of air, will materially aid the good effect of these 
measures. 

I might also speak in this chapter of certain 
vocal lesions, which may be developed under the 
influence of the gout and rheumatism ; but as 
the existence of these species of aphony is not 
sufficiently well-established, I can only point 



CHRONIC SCORBUTIC APHONY, ETC. 155 

them out, to warn the practitioners who may 
have an opportunity of observing them, that they 
must endeavor to recall the disease to its first 
place of selection by means of frictions, epispas- 
tics, cupping, moxas, warm baths, sudorific drinks, 
etc. It is useless to add, that all these thera- 
peutical measures should always be subjected to 
the type of the disease, and made to depend 
upon the circumstances and symptoms which are 
observed. 



CHAPTER XII. 

APHONY AND DYSPHONY SYMPTOMATIC OF OTHER 
PARTICULAR AFFECTIONS. 

In cunctis certas inquirere causas difficile est ! 

Frascator, Lib. 1. 

If, in most cases, aphony or dysphony result 
from a pathological condition of the vocal organs, 
taken as a whole or in part, these alterations of 
the voice are also, as we have already said, 
symptomatic of certain affections, and cannot 
then be studied by themselves in a practical rela- 
tion ; that is to say, independently of the morbid 
condition which has produced them. As the 
affections, which may occasion greater or less 
alteration in the emission of the vocal sounds, are 
as various as they are numerous, I will restrict 
myself, in this chapter, to speak of those which 
are the most frequent, and which I have myself 
most often observed. 



SYMPTOMATIC APHONY, ETC. 157 

ATONIC APHONY AND DYSPHONY. 

I mean, by atonic aphony or dysphony, that 
which depends upon one of the following causes : 

1. Upon atony, or want of power in the organs 
producing or modifying the voice. 

2. Upon atony of the primae vise. 

3. Upon general chlorotic atony. 

The aphony which is caused by atony of the 
organs modifying or producing the voice, is char- 
acterized by the absence of cough, the pale color 
of the pharyngean mucous membrane, joined to 
the difficult play of the superior constrictor 
muscles of the pharynx, of the muscles of the 
uvula, of the tongue, etc. In this case, if the 
disease seems entirely local, and not to depend 
upon one of the causes which have already been, 
or will hereafter be pointed out ; if the move- 
ments of the throat are merely difficult, without 
being painful ; if the patient enjoys, in other re- 
spects, good health, the physician may rest as- 
sured that he has a local atonic aphony to combat. 
This vocal alteration is one of the most frequent ; 
it is often caused by the prolonged exertion of 
the vocal organs in singing, declamation, and 
even ordinary speech. Thus it is very frequent- 
ly observed in lyric and dramatic artists, orators, 
persons of any profession requiring great display 
14 



158 THE VOICE. 

of the voice. This aphony is often intermittent, 
and liable to reappear after any vocal exertion 
whatsoever, and frequently, too, without any ap- 
preciable causes. An artist of the Theatre-Fran- 
cais, as distinguished for her wit as for her talent, 
Madam Talma, now Countess of Chalot, whose 
physician I have the honor to be, was obliged to 
quit the stage, where her career was so brilliant, 
because she was attacked with an aphony of this 
kind. I might cite a great number of instances 
of this kind of affection, which were caused by 
the abuse of certain tepid infusions, of cough 
drops or pills, too frequent bathing, local or 
general bleedings, which are always contra- 
indicated, and which increase the disease, even 
to rendering it sometimes incurable. 

To meet this kind of alteration of the voice, 
which is often only a dysphony, I employ the 
following measures : 

1. Gargles, at least three times a day, accord- 
ing to the following formula : 

Sulphate of Alum in powder, 1 drachm. 

Honey of Roses, 1 ounce. 

Filtrated decoction of Peruvian Bark, 8 ounces. 

Infusion of Roses, 6 ounces. 

Distilled Rose-water, 1 ounce. 

Subsequently, I increase the dose of alum, 
which may be gradually carried, according to the 



SYMPTOMATIC APHONY, ETC. 159 

circumstances, as high as six or eight drachms. 
M. Bennati, who has employed this substance 
with great advantage, says he has even used it 
of the strength of two ounces in ten of the decoc- 
tion of barley-water ; his formula will be given 
hereafter. To the use of the gargles I add fric- 
tions, every morning and evening, upon the 
anterior and lateral parts of the neck, with the 
following : 

Extract of Henbane, 6 grains. 

" of Belladonna, 6 grains. 

Balm of Gilead, 4 ounces. 

If the atonic aphony seems to be complicated 
by a slight paralysis of the laryngean nerves, 
I substitute the following liniment for the pre- 
ceding: 

Alcoholic Extract of Nux Vomica, 6 grains. 

Liquid Ammonia, 1 drachm. 

Camphorated Alcohol, 2 ounces. 

Oil of Sweet Almonds, 2 ounces. 

When the local aphony is nearly dissipated, 
and the voice has resumed its natural timbre, I 
advise the moderate exercise of the vocal organs, 
either in singing or in declamation. If the patient 
is a singer, he should not attempt lengthy pieces 
of music, but only to exercise upon the gamuts, 
at first in the medium voice, then in the base 
notes and the faucette, according to his vocal 



160 THE VOICE. 

organization. If the individual does not sing, he 
should read and speak in a loud voice without 
making any effort, and attempting to imitate the 
declamation of the recitatives, or to produce 
sounds approximating as much as possible the 
gamut in singing. This exercise, which should 
always be moderate and gradually taken, has for 
its object to strengthen the vocal organs, as slight 
exercise reestablishes the exhausted forces of a 
convalescent after a long disease. 

If the aphony is complicated with an atony of 
the primse vise, or a gastric embarrassment, the 
physician will have recourse first, either to emet- 
ics, or purgatives, to be afterwards followed by 
tonics, such as the preparations of Peruvian bark, 
iron, bitter drinks, etc., etc., the mineral waters. 
If the aphony depends upon a general chlorotic 
atony, to the measures already indicated will be 
added the bitter aromatic infusions, such as those 
of moth wort, saffron, sage, balm, etc. ; after- 
wards may be employed with advantage the more 
active tonic emmenagogues, as horse-chestnut 
bark, gentian, bitter quassia; the tinctures of 
cinchona, centaury, wormwood, may also be 
used with advantage. He will then resort to the 
chalybeate wines and other ferruginous prepara- 



SYMPTOMATIC APHONY, ETC. 161 

tions, such as iron-filings, the sulphate of the 
same metal, and the natural mineral waters. 

To bring back the menses, if they have not re- 
appeared, the treatment should be conducted as 
we have mentioned in sympathetic aphony ; the 
physician will employ stimulating injections, 
aromatic fumigations of the sexual parts, irritating 
fomentations on the hypogastric region, sinapisms, 
stimulating foot-baths, cupping, hot drinks, etc., 
etc. Finally, every eight days the application of 
two or three leeches should be made to the vulva, 
less with the intention of diminishing the quantity 
of blood than of directing it towards the uterus. 

Individuals laboring under one of the atonic 
alterations, of which we have exposed the princi- 
pal characters, should all first have recourse to 
the gargle, the formula of which has already 
been given. They should also strictly observe 
all the rules of hygiene, both in nourishment and 
drinks, and in clothing themselves suitably to the 
season. They should avoid sudden transitions 
from hot to cold, and should make frequent use 
of tepid bathing, in order to favor all the secre- 
tions and cutaneous perspiration, which should, 
however, always be moderate. 

14* 



162 THE VOICE. 



APHONY AND DYSPHONY FROM WORMS. 

I understand by worm-aphony that which is 
produced by the presence of worms in the diges- 
tive tube. Persons attacked with this species of 
aphony exhibit certain symptoms known to all 
physicians, but which it will, perhaps, notwith- 
standing, be useful briefly to run over, because, 
by not losing sight of them, the cause of the 
alteration or extinction of the voice is easily dis- 
covered. 

Patients experience disgust towards certain 
articles of food, and frequently have an excessive 
hunger returning at intervals ; they are generally 
tormented by frequent hiccough, nausea, eructa- 
tions of acid gas, and by a fatiguing salivation. 
They have rumblings in the bowels, colics, 
together with diarrhoea or tenesmus; the abdomen 
is clammy without marked pain ; if they are still 
young, they have dilated pupils ; they are tor- 
mented by buzzing in the ears, and great itching 
of the wings of the nose. Their eyes are sur- 
rounded by a dark ring, the countenance is livid, 
and often a slight dry cough is added to the other 
symptoms ; finally, as Rosen justly observes, they 
are relieved by the passage of some worms or 
some portions of them, which last sign is the only 



SYMPTOMATIC APHONY, ETC. 163 

positive evidence of the presence of these 
animals. 

To combat this worm-aphony the effort must 
be made to put an end to the cause producing it, 
by the use of purgatives, especially by castor-oil 
combined with the anthelminthic substances, as 
the chenopodium, the worm-seed ; finally, the 
treatment should be terminated by tonics, such as 
the preparations of iron and Peruvian bark ; after 
which the astringent gargles with the sulphate of 
alum or of zinc may be employed. 

NERVOUS APHONY AND DYSPHONY. 

Nervous aphony is the result either of some 
affection of the brain or pneumo-gastric nerves, or 
of an affection of the nerves peculiar to the larynx. 
This kind of aphony may also be caused by the 
use of alcoholic drinks, or the introduction into 
the economy of certain narcotic substances. 
Sauvage relates the curious case of some robbers, 
who rendered the persons they wished to rob 
mute from aphony, by compelling them to drink 
wine into which had been infused some grains of 
stramonium. 

Like all the functions which depend imme- 
diately upon the nervous system, the vocal 



164 THE VOICE. 

functions may experience various alterations 
from the slightest causes. Thus the nervous 
action, which presides over the motions of the 
larynx and glottis, may be suspended by many 
causes and particular circumstances, such as a 
sudden passion, anger, fear, the approach of an 
imminent danger, a fall, any sudden movement 
whatever. This last kind of aphony is usually of 
short duration. If the contrary should be the 
case, the same measures will be pursued as in 
the cases of aphony already mentioned, excitants 
of various kinds, such as frictions upon the ante- 
rior part of the neck with irritating liniments, 
blisters, moxas, cupping, setons in the neighbor- 
hood of the larynx ; lastly, electricity offers yet 
another resource from which good results may, in 
some cases, be obtained. 

There is also a kind of aphony or rather of 
nervous dysphony, which is characterized by a 
sort of barking produced by a convulsive condi- 
tion of this larynx. This species of dysphony 
which I have had an opportunity of seeing carried 
to a very great degree, yields almost always as if 
by magic to the well-directed employment of 
antispasmodics, especially to valerian tea and 
assafoetida pills. I might also introduce a case 
peculiar to myself, where, in addition to the 



SYMPTOMATIC APHONY, ETC. 165 

measures indicated, I made use of small moxas in 
the parts bordering on the larynx ; but I prefer to 
relate the following, which I observed in Hotel- 
Dieu, and which has likewise been narrated in 
the excellent thesis of my friend, Dr. Junot, of 
Yverdon. 

The patient who is the subject of this observa- 
tion, is a young child, ten years of age, lying No. 
63 in the hall St. Martha, who entered the Hotel- 
Dieu in the month of March. This little fellow 
was of a delicate constitution, and lymphatic 
temperament. He assigned the origin of his 
disease to a period six months preceding, but 
could give us no other details than the following : 
He related, that being suddenly taken with nausea 
and a desire to vomit, he remained affected with 
a sort of spasmodic convulsion of the larynx. At 
first he experienced only a slight difficulty in 
speaking, but soon the articulation of sounds 
became entirely impossible. The only treatment 
adopted by his physician was, to oblige him to 
take a decoction of grapes and of prunes ; but, 
as might have been supposed, the disease, far 
from amending, continued to grow worse. In 
this melancholy condition, the parents of the 
child brought him to the Hotel-Dieu, at Paris. 

The disease appeared to consist principally in 



166 THE VOICE. 

■ 

an alteration of the vital properties of the internal 
and external muscles of the larynx, which ceased 
to be under the influence of the will. The move- 
ments of this organ were great and hurried, to 
such a degree that it traversed the space of an 
inch, namely, half an inch in ascending and as 
much in descending ; these motions were exe- 
cuted with such rapidity, that the eye could 
scarcely follow them. From this cause the vocal 
canal was suddenly lengthened and contracted, 
and the irregularity of the spasmodic contraction 
and relaxation of the laryngeal muscles, especially 
of those intended to stretch the lips of the glottis, 
gave rise to sounds more or less acute and strong. 
The voice of this child was then modified in a 
vicious manner, closely approximating that of an 
animal, and might be compared to the barking of 
a dog. 

The treatment consisted in the use of an in- 
fusion of valerian, and the administration of pills 
of assafoetida. The cure was perfected in a few 
days, and the child was sent back to his parents 
having perfectly recovered the use of his speech. 

RELATIVE APHONY AND DYSPHONY. 

I designate by the name of relative aphony or 
dysphony, that which takes place only upon cer- 



RELATIVE APHONY, ETC. 167 

tain vocal sounds in the articulated or modulated 
voice ; for example, there may be an aphony in 
the articulation of a labial sound, although a 
lingual sound may be produced in all its integrity. 
Thus persons are often met with who cannot 
articulate ha, ma, pa, fa, va, and who can yet 
readily pronounce la, sa, ra, da ; and vice versa 
for all the syllables and all the sounds. It is the 
same with the voice modulated in singing ; thus 
there is often an aphony for the sounds of the 
faucette, while beautiful sounds may be poured 
forth for the base and medium notes. A perfora- 
tion of the palate, ulcerations upon this organ or 
in the isthmus of the throat, a falling down of the 
uvula, etc., may, according to our ideas of the 
formation of acute sounds, produce the relative 
aphony we have mentioned. These different 
vocal alterations, which are so often most im- 
properly confounded with stuttering, may be put 
to a distance. In other terms, there may exist 
as many kinds of aphony of this class as there 
are vocal sounds taken separately, or in combina- 
tion with consonants. From this it is manifest, 
that the voice has no special and exclusive organ, 
but an apparatus of organs, the injury of one or 
several parts of which, or still more the absence 
of these parts, necessarily constitutes vocal 



]68 THE VOICE. 

alterations, which vary with the kind and place 
of these lesions ; the causes of which must be 
sought for in the diversity of the organs com- 
posing the speaking apparatus. Upon the inves- 
tigation of these causes depends the treatment of 
relative aphony, which should always be modified 
according to their nature, and which it is, for this 
reason, almost impossible to point out. 



HOARSENESS, OR A COLD. 

It remains for me to say a few words upon an 
alteration of the voice, the most frequent of all, 
which is known by the name of hoarseness, or a 
cold. 

Hoarseness is always the result of a peculiar 
condition of the mucous membrane covering the 
vocal cords, or rather of a physical or sympa- 
thetic irritation of this membrane, which prevents 
the parts it lines from contracting properly to 
produce the sounds ; when the irritation is very 
strong it produces aphony or dysphony. 

To distinguish hoarseness from the two vocal 
alterations last mentioned, it will be sufficient to 
bear in mind, that in aphony the voice is entirely 
extinct, while in dysphony the sounds are merely 
either incompletely articulated or modulated, or 



RELATTVE APHONY, ETC. 169 

uttered with more or less pain. In hoarseness 
the voice is veiled, its timbre has lost its purity, 
it becomes obscure and baser ; the emission of 
sounds is possible, often complete, but harsh, and 
almost always takes place without difficulty. 
Finally, for the better understanding of the 
difference which lies between hoarseness and 
dysphony, I will add, that the former is found in 
affections situated upon the mucous membrane of 
the larynx and bronchi, while the latter takes 
place, in general, only in affections situated above 
the glottis, or in the pharynx. Thus there is 
hoarseness in colds, in slight inflammations of the 
larynx and bronchi ; on the contrary, dysphony 
occurs in inflammation of the uvula, tonsils, 
tongue ; in divisions of the veil of the palate, etc. 

I will, however, say a few words rapidly upon 
the causes of hoarseness, although, like the other 
alterations of the voice, it does not constitute a 
disease, but rather a symptom of some other 
affection, principally of a slight inflammation or 
a sympathetic irritation of the mucous membrane 
lining the vocal cords, or the trachea, etc. 

The causes of hoarseness are, in general, 

those of a cold or of an acute bronchitis of mild 

intensity ; that is to say, of inflammation of the 

mucous membrane, in which, as we have just 

15 



170 THE VOICE. 

seen, a change of vitality is produced, either by 
too great and prolonged cries and vocal efforts, 
or by some quite other irritation, such as the 
impression of cold directly upon the vocal organs, 
or on the external parts of these organs, or any 
other part of the body ; for example, the shoul- 
ders, arms, chest, and particularly the feet. To 
all these causes of hoarseness may be added those 
we have already pointed out for bronchitis, of 
which it is a symptom ; among these the prin- 
cipal are, the inspiration of irritating powders, 
those of chlorine, ammonia, etc., etc. When the 
hoarseness is accompanied by cough with expec- 
toration, it is then the principal symptom of a 
slight bronchitis commonly called a cold, of 
which we have already treated when speaking of 
acute bronchitis. 

Hoarseness is also one of the symptoms of 
several pulmonary diseases, but as affections of 
this class belong rather to the respiratory than to 
the vocal organs, we shall not treat of them. 

As the treatment of hoarseness depends upon 
the causes which have produced it, and as more- 
over this alteration is almost always the symptom 
of a bronchitis, we must refer for its treatment to 
that of this affection. (Vide the treatment of 
slight bronchitis,) 



CHAPTER XIII. 

PECULIAR MODIFICATION OF THE LARYNGO-PHARYN- 
GEAN MUCOUS MEMBRANE. 

After a long exertion of the vocal organs, and 
often too without any of those appreciable causes 
which we have assigned for the other alterations 
of the voice, the mucous membrane lining the 
vocal tube, especially of the isthmus of the throat, 
undergoes certain modifications, which seem to 
depend upon a change of vitality or a physiologi- 
cal lesion, the real cause of which cannot be cer- 
tainly recognised. 

This chronic modification, sui generis, of the 
mucous membrane often produces dysphony, and 
even sometimes aphony, of the kind distinguished 
by the epithet of relative. 

This kind of affection is sometimes character- 
ized by a species of buccal leucorrhea, or mucous 
discharge from the whole pharyngean cavity. The 
mucous membrane usually preserves its ordinary 
color, but it seems to be thickened and covered 



172 THE VOICE. 

with visible follicles and abnormal papillae, more 
or less prominent. 

Individuals suffering from this discharge, which 
differs from saliva, and may be compared to the 
mucous secretions of the nostrils, are constantly 
endeavoring to swallow, especially when they are 
about to speak or sing, and their voice soon loses 
its timbre and is changed into a true dysphony, 
similar to that resulting from an enlargement of 
the tonsils. It is not long since I had an oppor- 
tunity of observing a case of this kind in a young 
man. The use of astringent gargles at once gave 
him a marked amelioration, and the continuance 
of these measures soon completely triumphed 
over his dysphony. The gargle which I pre- 
scribed for him was prepared according to the 
following formula : 

Sulphate of Alum, 2 drachms. 

Red Wine, 6 ounces. 

Decoction of Peruvian Bark, 6 ounces. 

Honey of Roses, 1 ounce. 

This gargle should be employed three times 
a day. 

The condition and physiological modifications of 
the pharyngean mucous membrane have, then, a 
great influence upon the timbre of the voice, but 
yet this influence is still almost always badly ap- 
preciated ; this probably arises from the fact, that 



PHARYNGEAN MUCOUS MEMBRANE. 173 

individuals will persist in believing, that the larynx 
is the only vocal instrument intended exclusively 
for the formation of the voice. In consequence 
of this theory, too little attention has been given 
to the functions of the pharynx and to the part . 
taken by the throat, especially the veil of the 
palate, in the formation of the acute sounds. 

To prove that the condition of the mucous 
membrane of the superior part of the vocal tube 
plays, in the timbre of the voice, a part perhaps 
greater than that of the muscles intended to move 
it, I will relate what can bo observed in the vis- 
ible vocal organs of a person who is attacked 
with hoarseness. The mucous membrane is at 
this time redder than usual ; it also appears more 
swollen, drier, or more covered with the mucous 
secretions than in the natural state ; however, if 
all the parts composing the throat are attentively 
examined, it will be seen that they are capable 
as usual of executing all their movements, and 
that if observed separately or in connection they 
discharge their ordinary duty, although the voice 
may be altered in a more or less evident manner ; 
moreover, is not aphony seen suddenly to arise, 
from a momentary dryness of the laryngo-pharyn- 
gean mucous membrane, or the slightest irritation 
produced upon this membrane, either by the 
15* 



i 



174 THE VOICE. 

swallowing of an ice or a cold drink, or by the 
inspiration of an atmosphere too cold or too hot ? 
or even by other irritating agents, such as very 
slight cauterisation of the vocal cords ? In all 
these circumstances, the muscles and all the other 
parts of the vocal organs being in a state of per- 
fect integrity, the mucous membrane alone is 
found with certainty modified in its vitality, and 
consequently upon it alone depend the vocal 
alteration or complete aphony. A subject so in- 
teresting is well worthy of fixing the attention of 
physiologists, and would require a great number 
of observations and experiments to supply any 
thing useful in regard to the treatment of the vocal 
affections. 

Although I have said, at the commencement of 
this chapter, that it is difficult to appreciate and 
even precisely to estimate the cause of the modi- 
fication, sui generis, of the laryngo-pharyngean 
mucous membrane, such as I have pointed it out, 
I think, nevertheless, that this modification is the 
result of an irritation and of a latent and chronic 
inflammation, which has occasioned a vice in 
secretion or atony ; or, in a word, a change in the 
mode of vitality in the guttural mucous mem- 
brane. 



CHAPTER XIV. 

SORE THROAT, OR ACUTE AND CHRONIC INFLAMMA* 
TIONS OF THE PHARYNX. 



Aliter acutis morbis medendum, aliter vetustis, alitef increscen- 
tibus, aliter subsistentibus, aliter jam ad sanitatem inclinatis. 

Celsus Lib. — De Medicina. 



Although our principal object, in this work, 
has been only to occupy ourselves with the 
chronic affections which alter the voice, we think 
nevertheless that it will be useful to say some 
words upon the acute inflammations of the throat, 
which are frequently renewed in the chronic 
state, and are the most common causes of certain 
lesions, the medico-chirurgical treatment of which 
we have already exposed. 

If all parts of the body are liable to be attacked 
by inflammation, none are more exposed than the 
organs forming the throat, and especially the 
mucous membrane lining it. In fact, constantly 
under the influence of too cold or too hot an 
atmosphere, and irritated, too, by the frequent 



176 THE VOICE. 

movements occasioned by the articulation of 
words and the deglutition of food and saliva, the 
pharynx, for these reasons, is more liable than 
any other parts of the body, to inflammations 
more or less intense. Hence it is not difficult to 
explain the very great frequency of diseases of 
the throat, when we consider the changes of the 
seasons, and all the sudden variations of atmos- 
pheric temperature. 

All physicians are aware that when an organ 
is the seat of an inflammation, it swells, becomes 
painful, and its heat is always more or less aug- 
mented. All these characters are manifested in 
the gutturo-pharyngean inflammations, whether 
upon one part, or upon all those composing the 
throat. Thus the tonsils, or all the organs of the 
pharynx may be inflamed in different degrees, 
either separately or all at the same time, accord- 
ing to their sensibility and energy, and the fre- 
quence of action of the causes which have 
occasioned the disease. 

There are, then, guttural quinsies of different 
degrees, and pathologists have had reason to 
divide them into acute quinsies, simple or light, 
and into intense acute quinsy, called also sore 
throat, which is likewise terminated by resolution, 
often by suppuration, and sometimes by gangrene, 



SORE THROAT. 177 

which constitutes the gangrenous sore throat which 
we shall only mention. 

The causes of these quinsies are nearly the 
same with those which we have pointed out for 
bronchitis, and also for inflammations of the 
bronchi and larynx. The action of these causes 
has been more violent in some cases than in 
others. 

The usual causes of guttural quinsy are all 
those external impressions which act directly 
upon the region of the neck, whether internally 
or externally, and which occasion a flow of blood 
towards the superior parts. Individuals who take 
the fresh air morning or evening with the head 
and neck uncovered, whether at an open window 
or in the free air ; those who speak or walk in a 
direction opposite the wind ; those who ride on 
horseback, especially on the gallop, also facing 
the wind; lastly, those who, to escape from an 
excessive heat, suddenly leave the ball-room, the 
theatre, or any other place at a high temperature, 
without taking the precautions to cover them- 
selves and wait a short time in an apartment not 
so warm, are all liable to a more or less severe 
attack of quinsy. 

A sore throat often declares itself as soon as 
the individual is chilled or has wet his feet, or 



178 THE VOICE. 

because he has resided or only remained some 
instants in a damp apartment, or one recently 
washed. All the other causes which we have 
pointed out already as occasioning most of the 
vocal alterations, may also sometimes occasion 
guttural inflammations ; they are, the sudden 
suppression of a blister, a cautery, or an ulcer ; a 
cutaneous eruption healed, or rather driven back 
by the ill-iudged measures of quackery or igno- 
rance ; intemperance ; the neglect of bleeding or 
purging, when the custom has been long estab- 
lished; the suppression of an habitual nasal, 
menstrual, hemorroidal hemorrhage ; that of the 
perspiration, especially on the feet ; the fatigue 
produced by reading, declamation, singing in the 
high notes, reiterated cries ; the use of iced drinks, 
of irritating articles of food, of pepper, cloves, 
strong cordials ; the contact of some caustic sub- 
stances ; the custom of chewing hard bodies, dried 
fruits, sugar, filberts, walnuts, almonds ; the irri- 
tation occasioned by the presence of a foreign 
body, a fall, a blow, a wound upon the cervical 
region ; lastly, an hereditary disposition : all these 
may be predisposing or exciting causes of in- 
flammations of the throat. 

When the inflammation is seated upon the 
mucous membrane lining the pharynx, its princi- 



SORE THROAT. 179 

pal symptoms are an alteration of the voice, 
which becomes nasal, especially if the pituitary 
membrane is also invaded. At the accession 
deglutition is more or less painful, the inflamed 
mucous membrane is redder and drier than usual ; 
it appears shining, thick, and swollen, especially 
the uvula, the summit of which, tickling the base 
of the tongue, provokes nausea and frequent 
disposition to swallow. 

At a more advanced stage, a secretion of 
mucosity succeeds to the dryness of the throat ; 
and it is principally when the mucous membrane 
alone is inflamed, that that which covers the ton- 
sils is covered by a grayish mucus, or sprinkled 
with white sebaceous concretions. 

This inflammation, limited to the guttural mu- 
cous membrane, although less severe than the 
acute inflammations of the tonsils, presents a less 
painful and more ready deglutition than in this 
latter case, and a less marked alteration of the 
voice. It is, in general, of short duration, and 
almost always terminates in resolution ; it may, 
nevertheless, happen that in some cases it will 
occasion an abscess in the uvula or in the veil of 
the palate. When the abscess occupies the lat- 
ter organ it may be easily recognised by the 
arrangement of its two halves ; that which should 



180 THE VOICE. 

recede is elevated and convex ; the other, on the 
contrary, is depressed and concave. The uvula, 
on its part, presents a considerable swelling when 
it is the seat of an abscess, which may be readily 
recognised at a more advanced period by the 
fluctuation perceptible to the ringer at its project- 
ing part. These abscesses generally open of 
themselves ; but I think it is better to open them 
with a bistoury, used with prudence and precau- 
tion. 

This species of guttural angina sometimes fol- 
lows a chronic course, and always occasions 
dysphony ; it is also characterized by a slight 
uneasiness in deglutition, by a sensation of dry- 
ness and pain of little intensity in the isthmus of 
the throat; lastly, by the color of the parts, 
which are then a little redder than in the normal 
state. 

The inflammation of the throat is most fre- 
quently not limited to the mucous membrane, but 
although simple, and of slight intensity, the irrita- 
tion is also carried to the tonsils, and declares 
itself by a greater difficulty in swallowing. The 
inflammation often extends, and propagates itself 
into the nasal fossae, the tube of Eustachius, the 
larynx, the oesophagus ; also upon the mucous 
membrane of the mouth and salivary glands. It 



SORE THROAT. 181 

appears, therefore, that a simple inflammation of 
the pharynx may occasion at the same time a 
coryza, pains in the ears, incomplete deafness, 
often dysphony for the guttural and nasal sounds, 
an increase of difficulty in deglutition ; lastly, a 
more abundant secretion of the saliva, and of the 
mucosities of the mouth. 

Notwithstanding their number and the different 
accidents they occasion, all these symptoms may 
exist in simple inflammation of the throat, which, 
in this case, presents no grave character, and 
may be cured in a few days, when the irritation 
has not been allowed to reach an extreme degree. 

AY hen the inflammation from being moderate 
becomes more intense, it often invades with 
violence all the organs we have mentioned, or 
merely limits itself to some one particular part of 
them ; in these cases, the patients are exposed to 
danger in proportion to the severity of the in- 
flammation and the importance of the organ. 
When both tonsils are attacked at the same time, 
they may acquire a considerable size and impede 
deglutition, even so as to render it sometimes 
quite impossible. If the pain is often moderate, 
at other times it is acute, accompanied with heat 
and a constant disposition to swallow ; and this 
16 



182 THE VOICE. 

action is sometimes so painful as to give rise to 
contortions of all the muscles of the face. 

This melancholy condition of the patients is 
often rendered still more cruel by their constant 
desire to spit, and their efforts to reject the 
mucous secretions, which are thick and viscid. 
When the swelling of the tonsils is very consid- 
erable, the articulation of words is entirely im- 
possible ; and the utterance of the vocal sounds 
and respiration are executed with the greatest 
difficulty, so that frequently slight suffocations 
arise. 

The disease, carried to this degree, is always 
accompanied by fever, intense headache, general 
uneasiness, a thirst that cannot be satisfied ; some- 
times there is vomiting, and always nausea. 
If the uvula is attacked, liquids are still more 
difficult to be swallowed than solids, and the 
extreme swelling of the veil of the palate, and of 
the pituitary mucous membrane, renders the in- 
spiration of the air very painful, either because 
the entrance of the air-passage is diminished, or 
because the movements of the inspiratory mus- 
cles are so painful that they are in some sort 
condemned to inactivity. When the state of 
suffocation has reached this degree, it imperi- 



SORE THROAT. 183 

ously demands the most prompt succor and the 
most energetic measures. 

If the swelling of the parts does not oppose 
the sufficient opening of the mouth, the tonsils 
may be seen forming two tumors of considerable 
size, often leaving between them only a narrow 
space ; and sometimes these two glands are even 
seen to touch by their internal faces. 

The mucous membrane covering the tonsils 
always shares the inflammation of these glands ; 
sometimes it is dry and covered with whitish 
points, sometimes with a mucous secretion, and 
appears of a bright and deep red. When the in- 
flammation is limited to one tonsil, the swelling 
which exists only on one side, pushes the uvula 
to the opposite, to which we see the patients in- 
cline when they swallow their saliva or other 
liquids. 

The guttural cough and a laborious expectora- 
tion are also ordinary symptoms which are joined 
to those we have already pointed out ; more- 
over, it is not rare to see the whole pharyngean 
mucous membrane remain dry during the entire 
course of the disease ; the duration of which is 
usually from a week to a fortnight, rarely con- 
tinuing to the twentieth day. 

The treatment of guttural inflammations, like 



184 THE VOICE. 

that of all inflammatory affections, consists first in 
the removal of the causes which have produced 
them ; this is a condition, sine qua non, of a com- 
plete and lasting cure; next it varies with the in- 
tensity of the disease, the importance of the parts 
more particularly affected, and especially if the 
disease be acute or chronic. In other respects, 
the treatment must be conducted as in all the 
ether affections ; and the importance of this 
medical precept was well known even to the 
ancients, for, in his first book upon medicine, 
Celsus said, u Aliter acutis morbis medendum, 
aliter vetustis, aliter increscentibus, dliter sub- 
sislentibus, aliter jam ad sanitatem inclinatis." 

Whatever the nature and kind of the guttural 
inflammation may be, the patient should be 
recommended to keep as silent as possible, and 
to resist the disposition he has to be continually 
swallowing and spitting. The air he respires 
should be neither hot nor cold, and his drink and 
food should contain nothing irritating, either in 
temperature and consistence, or in their taste and 
chemical composition. To these measures should 
be joined rest of the body and mind, an elevated 
position of the head ; in short, every thing which 
tends to diminish the afflux of blood towards the 
inflamed parts. 



SOKE THROAT. 185 

If the disease is slight, and there is no reason to 
expect that it will become more severe, bleeding 
may be abstained from, and the physician will 
limit himself to the employment of irritating baths 
to the feet, soothing drinks, such as barley-water, 
pure or with a little milk, infusions of violets or 
mallows, decoctions of marsh-mallows sweetened 
with honey, or a soothing syrup, or acidulated 
according to the taste of the patient ; these drinks 
should be taken tepid or at the temperature of 
the room, according as they will be the easiest 
swallowed. 

Notwithstanding the employment of these 
measures, if the inflammation persists, or seems 
rather to increase than diminish, there should be 
no hesitation in combatting it by means of leeches 
applied to the part of the throat corresponding 
with the seat of disease ; it is well understood 
that the number of the leeches applied should 
always be in proportion to the intensity of the 
disease and the powers of the patient. In general, 
it is better to apply too many than too few, and 
the medium number, in ordinary cases in the 
adult, is twenty leeches. At the same time, 
poultices of flax-seed meal may be employed 
upon the parts affected ; if the odor from them be 
disagreeable, as it may be especially to females, 
16* 



186 THE VOICE. 

their place may be supplied by poultices of 
ground rice, starch, or the use of a bladder filled 
with tepid milk. At the same time, laxative 
drinks and mustard foot-baths may be employed. 
When the local pain has disappeared, but there 
still remains an alteration in the voice and an un- 
easiness in deglutition, caused by a swelling of 
the tonsils which is not dissipated, gargles slightly 
astringent may be employed, like those of the 
following formula : 

Of Infusion of Roses, 2 ounces. 

Of Barley-water, 2 ounces. 

Of Honey of Roses, 1 ounce. 

This gargle may likewise be employed : 

Of Buckthorn leaves, 1 large pinch. 

Of Agrimony, I large pinch. 

Boil them for a quarter of an hour in 

Common Water, 1 1-2 pounds. 

Strain, and add, 

Of Honey of Roses, or Raspberry Syrup, 2 ounces. 

It must be borne in mind, however, that these 
gargles must not be prescribed until the pain has 
ceased. While it continues, soothing gargles are 
alone efficacious ; the precaution must also be taken 
not to agitate them in the throat, as is commonly 
done, but simply to hold them in the back of the 
mouth as long as possible without making any of 
those motions which increase the guttural irrita- 
tion. The neglect of this precept may be one 



SORE THROAT. 187 

reason why this measure, often very beneficial, 
is sometimes attended with unfortunate results, 
because the efficacy of the remedy depends, in a 
great degree, upon the manner of employing it. 

If the disease increases in severity, and is ac- 
companied by a very marked febrile accession, 
blood-letting should be more strenuously insisted 
on, principally by general bleedings, local emol- 
lients upon the neck, rigid diet, complete absti- 
nence from drinks : recourse may also be had to 
the scarifying cups placed upon the neck; to 
mustard poultices, blisters, laxative injections of 
soap and water, honey, mercury; lastly, deriva- 
tives and external measures should especially be 
insisted on. In this case, the employment of 
emetics, recommended by some physicians, ap- 
pears to us more injurious than useful, because 
their principal effect is to provoke strong contrac- 
tions in the oesophagus and pharynx, and to in- 
crease at the same time the afflux and stasis of 
blood to the superior organs. 

When the inflammation is especially directed 
towards the tonsils, it occasions suppuration in 
them ; but it is rare that the abscess formed in 
them does not open of itself; the patient then 
suddenly finds himself relieved, sometimes at the 
very moment when his cure seemed the most 



188 THE VOICE. 

hopeless. In this case, the mouth should be im- 
mediately cleansed by means of a gargle of 
honey and barley-water ; and to hasten the cure, 
mild laxatives may be prescribed, as veal and 
herb broths, decoctions of tamarinds, ptisans of 
prunes, seidlitz waters, injections of honey, etc. ; 
finally, the gargles above mentioned, or, better 
yet, those composed of barley-water with honey, 
and slightly acidulated with vinegar or lemon 
juice, are, in this case, generally useful. 

As to the diet, it should vary with the circum- 
stances and the intensity of the guttural inflam- 
mation. Those articles of food should be pre- 
ferred which irritate the least by contact, such as 
milk, light broths, cooked fruits, creams, jellies of 
meat or fruits ; finally, all mild substances which 
require but slight motions for mastication or deg- 
lutition. 

As to the gangrenous angina, we think it best 
to abstain from speaking of it, both because it is 
happily rare and is almost always epidemic ; and, 
also, because it would draw us too far from the 
object of this work ; besides, the excellent labors 
of M. Bretonneau, of Tours, upon this subject 
may be consulted, in which will be found well- 
made observations, judicious remarks, a very rare 
medical tact ; in short, many proofs of his charac- 



SORE THROAT. 189 

ter as a wise and skilful physician. We shall, 
therefore, content ourselves with remarking, that 
when an individual finds himself in a district 
where this disease reigns epidemically, he must, 
upon the slightest symptom, call in his physician, 
and in all cases abstain from too energetic meas- 
ures. Debilitating medicines and bleedings are 
almost always injurious; while the nature of the 
disease and experience have established, in some 
cases, the efficacy of tonics, principally of bark. 
If the inflammation of the throat has passed 
into the chronic stage, it must equally be corn- 
batted, at first by antiphlogistics, derivatives, and, 
finally, by astringent gargles thus made : 

Barley-water, 8 ounces. 

Distilled Rose-water...... 1 ounce. 

Raspberry Syrup, 1 ounce. 

Sulphate of Alum, 1 drachm. 

To be employed three times a day till the cure 
is completed. 

If the swelling of the tonsils persist, the cau- 
terisations with a solution of nitrate of silver 
may be resorted to ; and if this measure does 
not succeed, and the hypertrophy is not the result 
of a scrofulous taint, excision of these glands 
may be practised, especially if the voice be 
altered, and deglutition impeded. 



190 THE VOICE. 

Before closing this chapter we will add a few 
words upon an inflammation of the pituitary 
membrane, vulgarly and improperly called a cold 
in the head. 

CORYZA, OR COLD IN THE HEAD. 

By this name is called the acute or chronic 
inflammation of the mucous membrane of the 
nasal fossae. If we speak of this affection in this 
work it is because we rank it among those which 
most frequently alter the voice. In fact, it then 
becomes nasal, harsh, and disagreeable, especially 
in the grave sounds and nasal syllables, the utter- 
ance of which requires the issue of the air at the 
same time from the mouth and nose. 

This affection, which is sometimes united with 
an inflammation of the pharynx, often develops 
itself without any appreciable cause ; but the 
impression of cold, especially upon the feet and 
head, although not a specific cause of cold in the 
head, is the most frequent occasional cause. If, 
almost always it manifests itself alone, it is in 
many cases united with other catarrhal inflamma- 
tions and exanthematous affections. 

This inflammation of the pituitary membrane 
at first manifests itself by a feeling of dryness 



SORE THROAT. 191 

and swelling, which, with the mucosities and the 
liquids secreted at a later period, opposes the pas- 
sage of air through the nose, and renders, for this 
reason, as we have already said, the vocal sounds 
harsh, nasal, difficult to utter, and disagreeable to 
hear. Smell and taste are, in general, very much 
blunted ; the forehead is often the seat of an 
acute pain and a manifest feeling of heaviness. 
The mucous membrane is redder than usual, and 
frequently this redness and swelling, of which it 
is the seat, are propagated towards the external 
parts, rendering the integuments of the nose and 
cheeks very sensible to pressure. The patients 
are then subject to frequent and painful sneez- 
ings, and to snuffling, excited by an inconvenient 
tickling of the nasal mucous membrane ; and by a 
continual desire to blow the nose, which requires 
frequent, but often useless efforts, especially when 
they endeavor to expel the matters which they 
think are in the nostrils. 

The secretions of the inflamed pituitary mem- 
brane vary at different periods ; in some persons 
they are suppressed from the beginning ; in the 
greatest number the nasal cavities exhale an 
abundant hot liquid, possessed of an acrid char- 
acter, which produces excoriations and small 
cracks in the wings of the nose and the upper lip. 



192 THE VOICE. 

At a later period, the matter secreted progressive- 
ly acquires more consistence, and becomes white, 
yellow, or greenish, according to the intensity of 
the inflammation; it also takes an insipid and 
sometimes fetid odor. Finally, it is dried in the 
form of crusts, and is driven out, either from the 
nostrils by blowing, or from the mouth, into which 
they have been drawn by snuffling. 

If this affection is sometimes very slight, it is 
often accompanied by a feeling of general unea- 
siness, and a febrile action which continues for 
several days ; in general, when the inflammation 
is intense, it is always followed by sleeplessness, 
disgust, a feeling of bruises and weariness in the 
limbs, headaches which render the sick incapaci- 
tated for manual and intellectual labors. 

The duration of the coryza is usually from 
four to seven days ; its course is often less rapid, 
and the disease may be prolonged for months, 
or even for a longer period, in some instances. 
The secreted matter is then clear and liquid ; it 
is rather a vicious secretion than a true inflam- 
mation. There are often, too, a succession of 
colds in the head, arising one upon the other. 

The termination of this inflammation always 
takes place by resolution ; we do not consider, as 
some authors pretend, that it takes place, unless 



SORE THROAT. 193 

as an exception, by suppuration, ulceration, gan- 
grene, cancerous thickening, etc. If all these 
cases have been observed, they have never com- 
menced by a true coryza, but have always been 
the consequence either of an exanthem, a wound, 
an erosion, or the action of some external cause, 
which has produced suppuration and the other 
consecutive phenomena we have, indicated. 

The treatment of this affection is very simple ; 
it consists in affording protection from the impres- 
sion of cold, irritating gasses, dust, etc. Patients 
should be directed, baths of mustard-water to the 
feet, hot diaphoretic drinks, such as infusions of 
elder, borage, linden. Where the disease is 
intense, diet, aromatic fumigations of burnt sugar 
directed towards the nasal cavities, blisters on the 
nape of the neck or behind the ears, and in some 
very rare cases the employment of bleeding are 
also measures, which arrest the progress of the 
disease and greatly hasten its termination. When 
the coryza seems to pass into the chronic state, it 
will be well at night to cover the forehead and 
nose with a cravat of muslin ; injections may be 
made into the nostrils of sweetened wine, and 
pinches of sugar reduced to an impalpable pow- 
der may be taken, as if it were snuff, several 
times a day. These measures, which I have fre- 
17 



194 THE VOICE. 

quently employed, have always given me good 
results. 

I shall close by saying, that individuals who 
have frequent attacks of coryza should take more 
precautions, and never lose sight of these words 
of Celsus : " Si diutius aliquem et vehementius 
ista sollicitare consuerunt, huic enim qusedam 
curiosior observa^o necessaria est.!" — Lib. IV. 



CHAPTER XV. 



GARGLES. 



The word gargle, — gargarismus of the Latin, 
from the Greek yccgyay^w, I icash the mouth, — 
signifies a liquid preparation intended to act upon 
the internal parts of the mouth and throat. 

When the mouth is only rinsed and the gargle 
is employed rather as measure of hygiene and 
cleanliness than as a medicament, all the muscles 
of the pharynx as well as those forming the 
cheeks, particularly the buccinators, should be 
contracted alternately. By these movements and 
the simultaneous or alternate contractions of the 
bucco-pharyngean organs, the liquid may be 
made to circulate into all the corners and upon 
all the guttural surfaces. But if the gargle is 
administered as a therapeutical agent, especially 
in acute inflammatory affections of the guttural 
organs, that it may not be rendered more inju- 
rious than useful, care must be taken not to con- 
tract the organs, as we have already mentioned ; 



196 THE VOICE. 

it will be better to retain the gargle as long as 
possible in the mouth, turning back the head, and 
avoiding agitation of the liquid ; without this 
precaution, the contractions and motions which it 
is customary to make, increase the irritation of 
the inflamed parts which require repose. It is 
the neglect of this precept, which has induced 
some practitioners to assert, that gargles were of 
more injury than use in inflammations of the 
throat, and that they increase the pain instead of 
diminishing it. 

If the seat of the disease be confined to the 
cavity of the mouth, the patient, instead of turn- 
ing back his head, should keep it level, so as to 
reject as easily as possible the liquid, and prevent 
it from penetrating either into the pharynx or air- 
passages. He should also avoid swallowing the 
gargle, especially if, as often happens, the sub- 
stances composing it are of a nature to irritate 
the digestive organs. 

Medical preparations of this kind usually act 
only locally, and their general effects are always 
nearly void, although the mucous membrane 
which lines the mouth and throat is very sensi- 
tive, and furnished with very numerous absorbent 
pores ; the action of gargles is constantly too 



GARGLES. 197 

sudden to allow the liquids to be absorbed, and 
carried into the circulation. 

Gargles are prepared from many substances ; 
and almost all soluble medicines, or which can 
be simply suspended in water or any other 
liquid, have been, or may be, administered in 
this form. Thus there are emollient, acidulated, 
astringent, tonic, narcotic, detergent, antisyphi- 
litic, antiscorbutic, and a host of other gargles, 
according as this or that medicament, having the 
properties mentioned, enters into their composi- 
tion. 

,The diseases in which gargles are employed 
are the following : inflammations of the mouth 
and tongue ; pharyngean inflammations, whether 
acute, simple, or complicated ; abscesses of the 
tonsils; atony; relaxation or paralysis of the 
organs of the throat; their inflammations; those of 
the palate and uvula ; procidentia of this organ ; 
apthae ; syphilitic, scorbutic, and scrofulous ul- 
cerations ; finally, all the affections situated in 
the bucco-pharyngean cavity. As we have often 
had occasion to employ different gargles in most 
of the affections noticed by us, we think it will 
not be amiss to make them known, as well as the 
circumstances requiring their use. 
17* 



198 THE VOICE. 



SOOTHING GARGLES. 



These are usually prepared with the mucil- 
aginous decoctions, roots of the marsh-mallow, 
flax-seed, pearl-barley, figs, and dates; or of 
milk, or infusions of the flowers of malvaceous 
plants. I have often employed with advantage 
the following : 

Decoction of Marsh-mallow Roots, 1-2 pound. 

" Figs 1-2 pound. 

Milk, 4 ounces. 

Mucilage of Gum Arabic, 1 ounce. 

This gargle is indicated in acute inflammations 
of the mouth and throat, in which it diminishes, 
in concurrence with other antiphlogistics, the heat, 
pain and irritation. 

ACIDULATED GARGLES. 

These are generally prepared with a decoc- 
tion of pearl-barley, or of marsh-mallows, acidu- 
lated with acetic or tartaric acid, lemon juice, 
gooseberries, strawberries, raspberries, etc., 
sweetened with honey, or some simple or acid 
syrup ; we prefer that of raspberries, because 
the acid it contains is united to a sort of muci- 
lage. The acidulated gargle, which we usually 



GARGLES. 199 

employ, is composed according to the following 
formula : 

Decoction of Pearl-barley, 1 pound. 

Honey of Roses, 1 ounce. 

Raspberry Syrup, 1 ounce. 

Lemon juice or Vinegar, 2 drachms. 

This gargle and others of the species are use- 
ful in anginas of slight intensity, not accompanied 
by fever ; they diminish the pain, and promptly 
appease the inflammation. 

TONIC AND ASTRINGENT GARGLES. 

They are ordinarily composed with decoctions 
of agrimony, Peruvian bark, tannin, gall-nuts, 
cashew, infusion of rose leaves, distilled rose- 
water, plantain, etc. We have prescribed the 
following : 

Distilled Rose-water, .4 ounces. 

Decoction of Agrimony or Peruvian Bark, 8 ounces. 

Raspberry Syrup or Honey of Roses, 1 ounce. 

Gargles of this kind are employed with ad- 
vantage in gangrenous inflammations, and espe- 
cially towards the end of certain chronic inflam- 
mations of the throat, with atony of the tissues. 

ASTRINGENT STYPTIC GARGLES. 

They are ordinarily prepared with pure water, 
a decoction of barley or red wine, with the addi- 



200 THE VOICE. 

tion of a mineral salt, which is most frequently 
the sulphate of alum, of zinc, of iron, etc. Those 
which have been generally employed by me are 
the following : 

Red Wine, 1 pound. 

Sugar, 1 ounce. 

Sulphate of Alum, 2 drachms. 

The dose of the salt may be progressively 
increased. 

another styptic gargle, by M. Bennati. 

Filtrated decoction of Barley, ] ounces. 

Sulphate of Alum, from 1 to 16 drachms. 

Syrup of Poppies, 1 ounce. 

These styptic gargles have been very often 
successfully employed by Dr. Bennati, and by 
myself, in the treatment of the aphony and dys- 
phony having for its cause either a particular 
modification of the bucco-pharyngean vocal or- 
gans, or a relaxation, and an atony of the mucous 
membrane lining these organs. They have, in 
some sort, in these cases a specific action, sui 
generis, which is incontestible. 

ANTI-SYPHILITIC GARGLES. 

The basis of these gargles is ordinarily the 
solution of the mercurial salts, principally of the 
bi-chloride or nitrate of mercury, sweetened with 



GARGLES. 201 

the syrup of poppies. I have employed the fol- 
lowing : 

Distilled Water, 8 ounces. 

Liquor Hy drargyri Oxymuriatis, 2 ounces. 

Sweeten with a sufficient quantity of the syrup of poppies. 

Not the slightest fraction of this gargle should 
ever be swallowed, or serious inconveniences 
may result. 

It is employed with advantage in venereal 
aphony and dysphony, in chancres and slightly 
painful ulcerations of the same nature, situated 
upon the veil of the palate, tonsils, etc., and not 
presenting the characters of active inflammation. 

ANTI-SCORBUTIC GARGLES. 

They are, in general, composed of tonic de- 
coctions of Peruvian bark, tannin, etc., and more 
particularly of the fresh juices and tinctures of 
the cruciferous plants, such as horseradish, coch- 
learia. This is the formula generally employed 
by me : 

Fresh Juice of Cochlearia, 4 ounces. 

" "of Horseradish, 4 ounces. 

Decoction of Peruvian Bark, 4 ounces. 

Sulphate of Alum, 1 drachm. 

It may be employed with advantage in vocal 
affections arising from a scorbutic taint. 



202 THE VOICE. 



ANTI-SCROFULOUS GARGLES. 

The tinctures and solutions of iodine and its 
different salts ; in short, all the preparations of 
this simple body, joined to the tonics and astrin- 
gents, are the basis of the anti-scrofulous gargles. 
The following formula has appeared to me of 
advantage in scrofulous vocal alterations : 

Distilled Water, 12 ounces. 

Pure Iodine, 2 grains. 

Iodide of Zinc or Potass, 4 grains. 

This may be sweetened with the syrup of 
orange flowers or violets ; but care must be taken 
to do it only at the moment when the gargle is to 
be employed, to avoid chemical decomposition. 

IRRITATING GARGLES. 

They are, in general, composed of irritating 
substances, such as the muriate of ammonia, 
liquid ammonia, in fractional doses and much 
diluted with water, pyrethrum, etc. ; they are 
useful in certain partial and incomplete paralyses 
of the tongue and pharynx. 

Gargles may also be made with muriatic and 
sulphuric acids largely diluted with water; they 
have the property of modifying the cancerous 
inflammations of the mouth and pharynx ; as also 



GARGLES. 203 

do those made of the nitrate of silver, in the dose 
of one grain to eight ounces of sweetened water. 
Gargles of the chloride of soda, in the propor- 
tion of one part to four of water, are also em- 
ployed ; these latter gargles have the peculiar 
property of modifying and even neutralizing the 
fetid odor which exhales from the mouth, espe- 
cially in complicated stomatitis, and the different 
gangrenes of the pharynx and cavity of the 
mouth. 

Before closing this chapter, it will be best to 
add some remarks upon the caustic substances 
employed in cauterisation of the vocal organs. 
These substances are muriatic and sulphuric 
acids, liquid nitrate of mercury, the nitrate of 
silver, the solution of this salt, powdered alum ; 
finally, pure creosote. 

The muriatic and sulphuric acids are employed 
pure, by means of a pencil made of a bit of 
wood, the extremity of which is feathered by 
cutting the end with a knife. The same method 
is employed with the liquid nitrate of mercury, 
often used to cauterise syphilitic ulcerations of 
the mouth, and which is prepared in the propor- 
tion of eight parts of nitric acid to one part of 
crystalized mercury. 

The nitrate of silver is employed either in the 



204 THE VOICE. 

solid form, vulgarly called infernal stone, or in 
the form of a solution applied very carefully by 
a sponge ; this aqueous solution should be made 
in the proportion of one part of water to one of 
the nitrate of silver. Finally, pure creosote may 
be employed as a caustic ; a solution of this sub- 
stance may also be prescribed with advantage, in 
the form of a gargle in the proportion of one part 
of creosote to eighty parts of water. The sul- 
phate of alum in powder may be employed by 
insufflation or immediate application. 



CHAPTER XVI. 

HYGIENE OF THE VOICE. 

After having exhibited the various mechan- 
isms of the production of the vocal sounds, and 
occupied ourselves with the causes, varieties, and 
treatment of the principal affections which occa- 
sion the alterations of the voice, we are naturally- 
led to add some remarks upon the special hygiene 
of the speaking organs, and upon the precautions 
to be taken, either to acquire a beautiful organ, 
or to preserve it when nature has thus en- 
dowed one. 

The development of the voice requires, there- 
fore, the most serious attention, and the vocal 
education should be commenced in infancy, by 
seeking, with all possible care, to obtain for an 
organ so admirable and precious, all the modifica- 
tions of which it is capable. 

From the first, the attention should be prima- 
rily directed to the development of the articulated 
voice, in order to impress in season, upon the 
18 



206 THE VOICE. 

flexible and elastic organs of children, the custom 
of performing those regular motions, which are 
indispensable to acquire at the same time a 
sonorous voice, a pure pronunciation, and natural 
and easy inflexions. 

This happy result may almost always be at- 
tained by exercising, at an early period, the chil- 
dren, either in speaking, or reading aloud ; but so 
as never to compel them by too great prolonga- 
tion of this exercise, or allowing them to take a 
tone too high or too low. They should, there- 
fore, be forbidden every sort of vocal display or 
forced cry, and thus prevent their vocal organs, 
so easily modified at this age, from assuming a 
harsh or sharp timbre, often too high, and very 
disagreeable to the ear. They should also be 
made strictly to pronounce all the syllables, 
and so govern their voices as to make every 
period of a phrase perceptible. They should 
also avoid respiring too often and too suddenly, 
which may give rise to a sort of hiccough, which 
not only may have the inconvenience of being 
ridiculous, but which may often even cause an 
irritation of the mucous membrane of the vocal 
cords, and produce an habitual hoarseness, some- 
times difficult to overcome. 

If the education of the articulated voice should 



HYGIENE OF THE VOICE. 207 

be commenced at a very early period, it is not 
the same with the modulated voice or singing ; 
for it is not till they are seven or eight years of 
age, that the attempt should be made to teach 
children to sing any gamuts. They will execute 
these gamuts softly, drawing out the sounds, but 
they should never extend their exercises beyond 
an octave in the medium, commencing at re be- 
low the lines for the grave sounds, and finishing 
at re within the scale for the acute sounds. They 
may, however, be allowed some notes of the 
faucette, if they take them without making any 
effort, always gradually, and at periods more or 
less remote, increasing a semi-tone, or, at the 
most, a tone at a time ; but they should never, in 
any case, exceed sol above the fifth line. 

These precepts concern not only the parents 
of children who have a natural disposition to sing, 
or who are intended to practise the teaching of 
music, or such a profession as that of singer, 
comedian, lawyer, etc. To the latter will be 
applied the precepts already given ; but the 
others, that is, those who are to be musicians, 
should be made to study the rules and mechanism 
of music till they are seven or eight years of age, 
which is, I repeat it, the period when they may 
be allowed to commence their singing, always 



208 THE VOICE. 

taking care not to prolong their exercises beyond 
a quarter, or, at the most, half an hour. By fol- 
lowing the course I have traced out, the vocal 
organs will every day acquire more flexibility 
and power, and a result will be obtained, which 
is very rare when this exercise of singing is 
commenced at a later period. 

At the season of puberty, that interesting and 
critical period of life, when a great revolution is 
effected in man, and when individuals of both 
sexes pass from childhood to adolescence, the 
vocal timbre is completely changed, especially in 
boys, who commonly lose an octave. That 
delicious and melancholy moment, in which we 
first experience the want of love, is not fixed in 
a precise manner ; but the voice then takes quite 
another character; it becomes, on a sudden, 
more hoarse, grave and harsh. This change is 
not usually of long duration, and the vocal 
organs have soon acquired from their new condi- 
tion more force and extent ; in man, the diapason 
of the voice usually lowers an octave ; in woman, 
on the contrary, the change is much less evident, 
and her vocal timbre, which always preserves 
more or less the character of infancy, has only 
gained in vigor and sonorousness. 

In general, when it is perceived that the voice 



HYGIENE OF THE Y0I 80S 

begins, to change, professors of music are, for 
the most part, in the habit of suspending all 
the exer; id even forbidding their pupils 

severely fro m s» alone. Although, at this 

critical period, the asm should be 

taken that the exercise of singing may not occa- 
sion a weakness of the vocal organs, the develop- 
ment of which might thus be arrested, I am not 
of the opinion of most teachers in this respect, 
and I think it is better to continue the exercises, 
even during the period of the transition, always 
taking the precaution to make them sang with the 
greatest prudence and reserve, without ever 
::' this. — that the exercises should 
never be allowed to exceed a quarter of an hour 
daily, and should a . e limited to an c : 

and a half, without ever permitting any efforts 
for the grave, and still less foi the acute souads. 
Moreover, a general rule to be observed is, 
study carefully the voice of the pupils, and to 
notice eve nave lost, in 

order not only to cut them out from their 

d not to allow the latter to extend, 

either in the grave, or acute notes, beyond the 

.aryngean note but one of the may 

have preserved. Finally, there will be a period 

of short duration when the vocal scale will 

18* 



210 THE VOICE. 

consist of an octave ; at this period alone do I 
advise the pupil to be allowed to repose, and to 
suspend all vocal exercises, which may be soon 
resumed, proceeding gradually from re below the 
lines to mi. Notes will afterwards be added as 
the voice increases in power and extent, 

The observance of these precepts, instead of 
fatiguing the vocal organs and ruining the voice 
of the pupils, renders more rapid, on the contrary, 
the physiological revolution of this organ, which, 
by a moderate exercise, will, at the same time, 
acquire in its development more suppleness, 
force and extent. If certain musical composi- 
tions, or an ill-directed exercise, have had the 
power to change the voice, and even taken all 
their measures from the pupils, it is because 
during the period of the transition they have not 
followed the precepts I have just given, and 
because they did not know how to govern their 
organs, by taking the precautions required at this 
critical period. 

I will not repeat what I have already said, 
(page 75,) upon the physical conditions to be pre- 
sented by those persons, who are intended for the 
exercise of singing or declamation ; I shall only 
assert, that it is not enough for them to have a 
pure and sonorous voice, a delicate ear, a just 



HYGIENE OF THE VOICE. 211 

intonation ; they should also have a well-formed 
chest, healthy, ample, contractile and expansible 
lungs. Those who do not present this conforma- 
tion, and also individuals of a slender, nervous 
constitution, or who take cold and cough upon 
the slightest causes ; lastly, those whose relatives 
have died of pulmonary phthisis, should all re- 
nounce the pursuit of the profession of singer, 
actor, lawyer, etc. The prolonged and frequent 
vocal exertions they will be called upon to make, 
will soon excite in them a disease, which is, un- 
fortunately, but too often beyond the resources 
of art. 

If parents and professors of music, whether in 
musical academies, or in the city, would more 
frequently observe the precautions I have given, 
there would be fewer victims to their voices, and 
the increasing want of singers distinguished for a 
flexible and extensive voice would not be daily 
felt. 

When a singer is endowed with a happy con- 
formation, and a vocal organ pure, flexible, and 
sonorous, all his cares should be directed to pre- 
serve it in its purity and suppleness. I will 
therefore repeat, in a few words, the hygienic 
rules which will aid him to obtain most easily 
this result, and I will, at the same time, point 



212 THE VOICE. 

out to him, not only what he should do, but also 
what he should avoid, to withdraw himself from 
the dominion of the causes, which occasion the 
most frequent vocal affections. 

From the first, those persons who devote them- 
selves to the practice of singing, should more 
than any others avoid all impressions of a cold 
atmosphere, and conform less to the tyrannical 
power of certain fashions, to which women are 
more enslaved than our own sex. Notwithstand- 
ing the severity of the season, they expose to the 
action of the cold their bare arms and neck, and 
they may often be seen to shiver under garments 
so thin and short, as scarcely to suffice for de- 
cency. Thus dressed, these victims of fashion 
plunge rapidly from an icy atmosphere into a hot 
air, or repass from this latter, often panting from 
perspiration, into a temperature of ice : but too 
fortunate, if they escape with a cold or an altera- 
tion in the voice. But death often succeeds such 
pleasures ; or still more to be lamented, we see 
young persons painfully drag on the remainder 
of their existence, which seems to be prolonged 
only to allow them the mournful recollections of 
the past. 

Singers should therefore avoid the unhappy 
impressions of cold, inasmuch as nothing more 



HYGIENE OF THE VOICE. 213 

readily induces catarrhal affections of the vocal 
organs, whether by being brought in contact with 
their mucous surface by the inspiration of the air 
or the deglutition of an iced liquid, or if it be 
primarily directed upon the cutaneous surface. 

When, from peculiar circumstances, as hap- 
pens to all dramatic artists, the individual is com- 
pelled to have some part of the body for a longer 
or shorter time uncovered, there are certain pre- 
cautions to be taken, which will diminish, in a 
great degree, the unhappy influence of the cold. 
Thus, instead of remaining near a hot fire until 
the moment of appearing on the stage, he should 
be contented with merely warming himself a few 
moments, and should endeavor to preserve this 
artificial heat by walking and making some mo- 
tions ; care should be taken at the same time to 
cover a little the parts which are to be exposed to 
the cold air, in order that they may be less sensi- 
ble when they are brought in direct contact with 
it. To render the bronchial mucous membrane 
also less susceptible, it will be well to keep up 
some slight excitement of the skin by wearing 
flannel waistcoats, and avoiding as much as possi- 
ble cold and damp feet ; for this purpose, flannel 
hose may be worn covered immediately with hose 
of gummed taffeta. 



214 THE VOICE. 

The use of hot drinks, of pepper, checkerberry, 
alcoholic drinks, gargles of the same nature fre- 
quently repeated, the inspiration of snuff, of thick 
smoke, of different gasses, of dust, etc., by irri- 
tating the bronchial and laryngo-pharyngean 
mucous membrane, are injurious to singers, and 
may at length occasion a hoarseness or even a 
complete aphony. The use of snuff is equally 
injurious to the beauty of the vocal sounds, 
especially in the base notes, for it thickens and 
irritates the pituitary membrane, and thus, to- 
gether with coryza, renders the voice harsh and 
nasal. 

Singers should also be careful to use only sup- 
ple cravats, of a soft tissue ; they should not tie 
them too tight, for by compressing the larynx 
they impede the voice, especially in the base 
notes. In tenors and soprani they may cause a 
sudden attack of apoplexy during the mainte- 
nance of a high and prolonged note. 

Females should abstain from lacing their cor- 
sets too tight, which, by opposing the dilatation 
of the chest, often compels them to respire out 
of season, and prevents them from profiting by all 
their powers and the extent of their voices. The 
abdominal supporters moderately tight may be 



HYGIENE OF THE VOICE. 215 

useful to base singers, who are more disposed 
than others to obesity and abdominal hernia. 

Frictions of the skin from time to time with a 
flannel, or a fine brush, stimulate the cutaneous 
surface, and combat more or less the tendency of 
certain singers to catarrhal affections. It will 
also be useful (I speak to singers by profession) 
not to sing for some hours after eating, because 
when the stomach is distended by food, the size 
of this organ prevents the depression of the dia- 
phragm ; wherefore, the respiratory functions are 
not so well executed. 

Of all excesses, that which is the most injuri- 
ous to singers is, without doubt, that of the pleas- 
ures of love ; I might instance several cases of 
individuals who have completely lost their voices 
in consequence of excesses of this kind. M****, 
an old, distinguished singer of the Italian Theatre, 
was attacked with complete aphony after a night 
of debauch. Those who would preserve for a 
long time a beautiful organ and a pure and sonor- 
ous voice, should practise the utmost reserve in 
the pleasures of Venus. It is the same with that 
shameful vice of onanism, which make so many 
victims in both sexes, and which is perhaps as 
often the cause of the hoarseness of the voice at 
the period of puberty as puberty itself. The 



216 THE VOICE. 

very great sympathy between the sexual and 
vocal organs easily explains why the least ex- 
citement of the former reacts promptly upon the 
larynx, and immediately makes its pernicious in- 
fluence felt upon the timbre of the voice. 

Singers should also abstain from singing in the 
open air, especially in the evening, when the 
temperature is cold and moist ; the neglect of this 
hygienic precept will be attended with yet more 
serious consequences, if the singing, or even 
speaking, is performed with the face turned 
towards the wind. When obliged to go out 
during a damp and low temperature of the atmos- 
phere, the singer will take the precaution always 
to carry his handkerchief before his mouth and 
nose ; in this way he will always respire a tem- 
perate air, and be withdrawn from the irritating 
action of the cold. Martin, our celebrated singer, 
whose admirable voice is still so pure, so flexible, 
and so extensive, never fails to take this precau- 
tion. 

Females, at the period of their menses, will do 
well to wear drawers of flannel, as they are then 
more impressible ; they will thus avoid painful 
menstruation and suppressions, which always 
affect the voice and often the health. It will be 
even prudent for them not to sing at these periods, 



HYGIENE OF THE VOICE. 217 

especially the great airs of our modern operas ; 
their vocal timbre being then always less pure, 
and the emission of the voice less easy, they may 
become more readily fatigued than at any other 
period, and at the same time expose themselves 
to a poor appreciation of their talents and powers. 
Females who are encientes should for the same 
reasons sing less frequently and for a shorter 
time ; during the duration of their pregnancy 
they are more liable to hoarseness, dysphony and 
aphony. 

However useful the moderate exercise of sing- 
ing may be, by the movements which it impresses 
upon the pulmonary system and all the muscles 
of the chest and abdomen, in the same propor-' 
tion is its excess injurious. What is said with 
regard to the modulated voice applies equally 
well to the articulated ; the rules are nearly the 
same for singers, actors, lawyers, clergymen, etc., 
and in general for those who speak often and 
with ardor, and for a long time. All, especially 
at the age of adolescence, when the pulmonary 
system is developed, are liable to the spitting of 
blood, aneurismal dilatations of the heart and large 
vessels, and to acute and chronic diseases of the 
chest and vocal organs, properly so called. These 
accidents are occasioned, generally, by the long 
19 



218 THE VOICE. 

expirations they make, and the too rare or sudden 
deep inspirations, to which they are subjected. 
The great art of singers and of orators is to know 
when to respire, and never to attempt, by efforts 
and display of the voice, to exceed the extent of 
their means and vocal power. 

If I were not apprehensive of being drawn 
into too lengthy considerations, I might add a 
host of hygienic precepts in relation to those who 
exert their voices much, whether in singing, or in 
declamation. Without entering, in this respect, 
into lengthy details, which are rendered less 
necessary by the advice already given, I will add, 
that those who devote themselves to exercises of 
the voice, should always do it with moderation, 
especially at the earlier periods, and they cannot, 
without great danger, attempt to change the kind 
of voice which nature has imparted to them. 
They should lead a sober life, using all things 
and abusing nothing. Finally, they, even more 
than all other men, should never lose sight of 
these precepts of Hippocrates^ which, in some 
sort, comprise all the rules of hygiene, — Mode- 
rata durant, atque vitam et sanitatem durabilem 
prozstant ; " and that general law of the old 
man of Cos, included in these eight words, — " La- 
bor, cibus, potus, somnus, venus, omnia sunt 
mediocria." 



HYGIENE OF THE VOICE. 219 

Notwithstanding all the precautions we have 
recommended, as soon as persons who devote 
themselves to exercises of the voice perceive a 
spitting of blood, however slight, with a dry 
cough ; as soon as they find themselves growing 
thin, they should abstain from singing, under 
penalty of an early death from pulmonary or 
laryngeal phthisis. To avoid hemoptysis and 
sanguineous congestions of the superior parts of 
the body, the employment of moderate bleedings, 
and the use of foot-baths cannot but prove ad- 
vantageous ; so, also, to remedy the other acci- 
dents, and to dissipate the fatigue, which is often 
the result of singing, it will be well to follow the 
counsels of Galen, who directed the frequent use 
of warm baths, with the view of sustaining the 
clearness, purity, and force of the voice. 

To terminate our remarks upon the hygiene of 
the voice we will add, that if the exercise of this 
organ, carried beyond certain limits, may prove 
injurious to the health, the exercise of singing, 
when it is moderate, can calm our agitated minds, 
reanimate our exhausted powers, arouse our 
courage ; finally, become a sort of instinctive 
relief, to enable us to support our troubles and 
hardships. The sailor upon the sea, the traveller 
on his weary way, the captive in his prison, the 



220 THE VOICE. 

laborer, the artisan, the shepherd, and the soldier, 
all sing, as it were mechanically, to suspend or 
dissipate their fear, their sadness and fatigue. 

We shall be but too happy if the counsels we 
have thus rapidly given prove useful to some. 
In giving them, we were of opinion, that the 
physician who seeks to preserve the health of his 
fellow-citizens is, at least, as useful as he who 
cures their diseases. It is for us to say with 
Seneca, that it is a greater service to support one 
who is upon the point of falling, than to raise him 
up after he has fallen : " Pluris est labantem 
sustinere, quam lapsum erigere." 



